Minor surgery in general practice in Ireland- a report of workload and safety.

BACKGROUND: The provision of minor surgical services is an established part of the task profile of general practitioners (GPs) in many countries in Europe and elsewhere. This study aimed to collect data on the clinical process and outcomes for specified minor surgical procedures undertaken in Irish general practice by GPs experienced in minor surgery in order to document the scope and safety of minor surgery being undertaken. METHODS: Over a six-month period, 24 GPs in 20 practices recorded data on a pre-determined list of procedures undertaken in adults (aged 18 and older); procedures for ingrown toenails were also recorded for those aged 12-18 years. Clinical data were rendered fully anonymous by the participating GPs, entered onto the Excel database template and returned to the project team monthly. RESULTS: On average, each practice undertook 212 procedures in a six-month period. The four most frequent procedures include two relatively non-invasive procedures (cryosurgical ablation of skin lesions and aspiration and/or injection of joints) and two more invasive procedures (full thickness excision of skin lesion and shave, punch or incisional biopsy). Overall, 83.8% of relevant specimens were submitted for histology. Combining benign and malignant cases, there was an overall 87% clinical and histological concordance; 85% of malignancies were suspected clinically. A complication was recorded in 0.9% after 1 month. CONCLUSIONS: Irish GPs with experience in minor surgery can provide a range of surgical services in the community safely.

An Evaluation of a Practice-Based Minor Oral Surgery Service.

AIM To report the findings of a service evaluation of an NHS practice-based minor oral surgery service. METHOD A service evaluation including a retrospective analysis of activity and outcome data and assessment of patient and practitioner satisfaction. RESULTS 623 appointments were arranged, with a mean waiting time of 43 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (29.7%, 44.1%, 3.0% and 23.4% of cases respectively). Antibiotics were prescribed at 16.1% of treatment appointments and 1.9% required appointments for post-operative complications. All participants reported overall satisfaction with their care and strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding and acceptance; 77.5% were seen on time and none were seen more than 15 minutes late; 87.5% felt the standard of the service was better than expected than at a hospital and none felt it was worse. Over 80 of practitioners agreed that waiting times were better than expected at a hospital, urgent problems were seen quickly and the referral process was easy and understandable. All practitioners strongly agreed/agreed they that they were happy with the service provided. CONCLUSIONS A range of minor oral surgery procedures can be provided with low complication rates, acceptable waiting times and accessibility, and high patient and referring practitioner satisfaction from a practice-based specialist oral surgery service.

Calidad percibida por usuarios de cirugía menor según nivel asistencial y profesionales que la realizan / Quality perceived by users of minor surgery according to care level and the professionals that carried it out

Fundamentos. La cirugía menor es realizada actualmente por diversos profesionales en atención primaria y especializada. Como tecnología sanitaria debe ser evaluada para conseguir una eficiencia organizacional. La satisfacción del usuario es uno de los criterios de calidad. Por ello se plantea un análisis de la calidad percibida por el usuario según dónde y quién realice cirugía menor. Métodos. Se estudió por encuesta telefónica la satisfacción de una muestra de 275 pacientes de cirugía menor pertenecientes a dos hospitales y tres áreas de atención primaria de Asturias. El cuestionario sigue el modelo SERVQUAL adaptando el utilizado por el Ministerio de Sanidad en 1977. Se establece un modelo de comportamiento de la satisfacción en función de las variables que la incrementan o disminuyen. Resultados. En todos los ítems la satisfacción fue buena o muy buena como mínimo en el 84% de los encuestados y en la mayoría estaba por encima del 95%. Había una diferencia significativa, a favor de atención primaria en tiempo de espera (p<0,001), explicaciones recibidas (p=0,002) y seguridad percibida (p=0,015). Las variables más explicativas de una satisfacción excelente fueron la sensación de seguridad y la atención del personal. El tipo de profesional no apareció como condicionante y el nivel asistencial solo apareció entre los que no se sentían muy seguros, en cuyo caso estaban menos satisfechos los atendidos en atención primaria. Conclusiones. La buena calidad percibida por los usuarios no penaliza el que la cirugía menor sea realizada en ninguno de los niveles asistenciales ni por ninguno de los profesionales que la realizan actualmente

Background. Nowadays minor surgery is performed by different professionals at primary as well as specialized care. Being a healthcare technology, minor surgery must be assessed in order to achieve an organizational efficiency. User’s satisfaction must be one of the quality criteria. That is why an analysis of the quality perceived by users according to where minor surgery takes place and who carries it out is made. Methods. This study explores, conducting telephone surveys, the satisfaction of a sample of 275 minor surgery patients of two hospitals and three primary healthcare areas of Asturias. The sur- vey is based on the SERVQUAL model adapting the one used by the Spanish Ministry of Health in 1977. A behavior pattern of satisfaction was established in terms of the variables that increase or diminish it. Results. In every item, satisfaction was perceived as good or very good at least in 84% of the survey users and in the majority was over 95%. There was a significant difference in favour of primary care with respect to waiting time (p<0,001), explanations received (p=0,002) and security perceived (p=0,015). The more explanatory variables of excellent satisfaction were the sense of security and the staff attention. The kind of professional did not represent a conditioning factor and the level of healthcare only appeared to be so among those who did not feel safe showing to be less satisfied those treated in primary care. Conclusions. Good quality perceived by users does not seem to be penalized by the fact that minor surgery can be carried out at different healthcare levels or which specialist performs it

Differences in medical services in Nordic general practice: a comparative survey from the QUALICOPC study.

OBJECTIVE: We aim to describe medical services provided by Nordic general practitioners (GPs), and to explore possible differences between the countries. DESIGN AND SETTING: We did a comparative analysis of selected data from the Nordic part of the study Quality and Costs of Primary Care in Europe (QUALICOPC). SUBJECTS: A total of 875 Nordic GPs (198 Norwegian, 80 Icelandic, 97 Swedish, 212 Danish and 288 Finnish) answered identical questionnaires regarding their practices. MAIN OUTCOME MEASURES: The GPs indicated which equipment they used in practice, which procedures that were carried out, and to what extent they were involved in treatment/follow-up of a selection of diagnoses. RESULTS: The Danish GPs performed minor surgical procedures significantly less frequent than GPs in all other countries, although they inserted IUDs significantly more often than GPs in Iceland, Sweden and Finland. Finnish GPs performed a majority of the medical procedures more frequently than GPs in the other countries. The GPs in Iceland reported involvement in a more narrow selection of conditions than the GPs in the other countries. The Finnish GPs had more advanced technical equipment than GPs in all other Nordic countries. CONCLUSIONS: GPs in all Nordic countries are well equipped and offer a wide range of medical services, yet with a substantial variation between countries. There was no clear pattern of GPs in one country doing consistently more procedures, having consistently more equipment and treating a larger diversity of medical conditions than GPs in the other countries. However, structural factors seemed to affect the services offered.

Descripción de la concordancia clinicopatológica y satisfacción del paciente en la cirugía menor en un centro de atención primaria / Description of clinical pathological concordance and patient satisfaction in minor surgery in a Primary Care centre

OBJETIVO: Describir las características de la cirugía menor (CM) en un centro de atención primaria (AP) evaluando la concordancia anatomopatológica y clínica, así como la satisfacción del paciente. DISEÑO: Estudio descriptivo y retrospectivo. EMPLAZAMIENTO: Atención primaria, Centro de Salud (CS) urbano en Almería. PARTICIPANTES: La población fueron los usuarios pertenecientes al CS urbano derivados por sus médicos de familia o pediatras para realización de CM a la consulta durante el año 2013 que consintieron la intervención. Se obtuvo una muestra de 223 pacientes. MEDICIONES PRINCIPALES. Las variables analizadas fueron: sexo, edad, localización de las lesiones, tipo de intervención realizada, diagnóstico clínico, diagnóstico anatomopatológico, complicaciones y satisfacción del paciente. Los datos fueron extraídos de la historia clínica, de los informes de anatomía patológica y mediante encuesta de satisfacción realizada vía correo y telefónica a los pacientes. RESULTADOS: En nuestra población la mayoría fue del sexo masculino 53,8%, la edad media fue de 51,12 años con desviación típica de 19,02, la localización de las lesiones que más se intervinieron fue en la cabeza (35,4%). El procedimiento más utilizado fue la electrocirugía (62,8%), biopsiándose solo el 16,9% de las lesiones, de las cuales las más frecuentes fueron los fibromas (32,3%), obteniéndose una correlación clinicopatológica >80% con un índice Kappa de 0,783 (p < 0,001). El número de complicaciones fue bajo. La satisfacción del paciente fue alta. CONCLUSIONES: Aunque se han generalizado técnicas sencillas de CM, como la electrocoagulación, en AP la CM sigue siendo segura y satisfactoria para el usuario

AIM: To describe the minor surgery (MS) characteristics in a Primary Care (PC) centre, and to evaluate the clinical pathological concordance and patient satisfaction. DESIGN: Descriptive and retrospective study. SETTING: Primary Care, urban health care centre, Almería, Spain. PARTICIPANTS: The population were the patients belonging to urban Primary Health Care centre, referred by their family physicians or paediatricians for the performing of MS during year 2013, and who consented to the intervention. A sample of 223 patients was obtained. MAIN MEASUREMENTS: Variables analysed were: sex, age, locations of the lesions, type of intervention, clinical diagnosis, histopathology diagnosis, complications, and patient satisfaction. The data were extracted from the medical history, the histopathology reports, and by using a satisfaction questionnaire completed by post or telephone by the patients. RESULTS: The population consisted of 53.8% males, and had a mean age of 51.12 years (SD 19.02). The location of the most intervened lesions was in the head (35.4%). Electro-surgery was the most used procedure (62.8%), with only 16.9% of the lesions being biopsied, of which the most frequent was fibroids (32.3%). The clinical pathological concordance was > 80% and the Kappa index was 0.783 (P <.001). The complications presented were low. The patient's satisfaction was high. CONCLUSIONS: Although a simple MS technique like electro-surgery has become more extensive, MS in PC remains safe and satisfactory for the user

Safety of community-based minor surgery performed by GPs: an audit in different settings.

BACKGROUND: Minor surgery is a well-established part of family practice, but its safety and cost-effectiveness have been called into question. AIM: To audit the performance of GP minor surgeons in three different settings. DESIGN AND SETTING: A community-based surgery audit of GP minor surgery cases and outcomes from three settings: GPs who carried out minor surgery in their practice funded as enhanced (primary care) services (ESGPs); GPs with a special interest (GPwSIs) who worked independently within a healthcare organisation; and GPs working under acute trust governance (Model 2 GPs). METHOD: An audit form was completed by volunteer GP minor surgeons. Data were collected about areas of interest and aggregated data tables produced. Percentages were calculated with 95% confidence intervals (CIs) and significant differences across the three groups of GPs tested using the χ(2) test. RESULTS: A total of 6138 procedures were conducted, with 41% (2498; 95% CI = 39.5 to 41.9) of GP minor surgery procedures being on the head/face. Nearly all of the samples from a procedure that were expected to be sent to histology were sent (5344; 88.8%; 95% CI = 88.0 to 89.6). Malignant diagnosis was correct in 69% (33; 95% CI = 54.2 to 79.2) of cases for ESGPs, 93% (293; 95% CI = 90.1 to 95.5) for GPwSIs, and 91% (282; 95% CI = 87.2 to 93.6) for Model 2 GPs. Incomplete excision was significantly more frequent for ESGPs (17%; 9; 95% CI = 7.5 to 28.3, P<0.001). Complication rates were very low across all practitioners. CONCLUSION: GP minor surgery is safe and prompt. GPs working within a managed framework performed better. Consideration needs to be given on how better to support less well-supervised GPs.

Survey on choice of intravenous sedative agent at department of dental anesthesiology, Tokyo Dental College Chiba Hospital between 2010 and 2011.

Use of intravenous sedation is increasing in the management of dental patients in consideration of accompanying diseases and patient demand for comfort and safety. We surveyed choice of sedative agent and dosage on the basis of accompanying diseases or conditions in patients receiving treatment at the Department of Dental Anesthesiology, Tokyo Dental College Chiba Hospital between 2010 and 2011. A total of 5,256 patients were reviewed and divided into the following categories: 1) medically compromised patients (MC); 2) minor oral surgery (OS); 3) cerebral palsy (CP); 4) mental retardation (MR); 5) mental disorder (MD); and 6) dental phobia with/without gag reflex. The investigated variables were sex, age, weight, duration of sedation, and dosage of agent. Dosage of midazolam (M), M plus propofol (MP), and P alone was investigated. A total of 2,336 patients were managed by intravenous sedation during the study period. The combination of MP was used in approximately 63-79% of patients in all categories, except MC. Midazolam was used in approximately 47% in the MC group. Propofol was used in approximately 32% of patients in the MR group. Other agents (minor tranquilizers, analgesics, and so on) were used in approximately 12% in the OS group. The dose of M was approximately 0.05-0.06 mg/kg. When MP was administered, the dose of M showed no difference among groups. The dose of P, however, tended to be lower in the MC and CP groups than in the other groups. These results suggest that MP is chosen for intravenous sedation in most types of dental treatment.

Canalicular laceration repair: an analysis of variables affecting success.

PURPOSE: To evaluate the outcomes of all canalicular lacerations at a high-volume urban tertiary eye care center and calculate the impact of variables of repair on success. METHODS: A retrospective review over a 10-year span of all primary canalicular laceration repairs was performed. Variables included patient demographics, repair setting, surgeon level of training, mechanism of injury, associated injuries, type of stent used, and success of repair. RESULTS: One hundred thirty-seven patients met the inclusion criteria and were used for analysis. The mechanism of injury was primarily due to altercations (31.4%), followed by accidents (21.9%). Most repairs were performed in the operating room (72.3%) with an overall success rate of 85.9% compared with 36.8% in the minor procedure room. The success rate varied significantly by level of training, with a fellowship-trained oculoplastic surgery attending physician attaining the highest success rate of 84.0%. The success by primary surgeon training level was statistically significant (p<0.0001). The efficacy of a monocanalicular stent was also studied and was not significantly different from bicanalicular stenting when other variables were accounted for (p=0.1186). CONCLUSION: The overall success of canalicular laceration repair is good. However, the setting of repair and level of training greatly affect the success of repair. In a tertiary care setting, an attending surgeon with subspecialty training in oculoplastic surgery should participate in the canalicular laceration repair to maximize the success rate. Performing the repair in the operating room rather than a minor procedure room setting may further improve the patient outcomes.

Operative surgical yield from general surgical outpatient clinics; time to change the way we practice?

The aim of this study was to compare the number of patients attending surgical outpatient clinics in a general hospital to the number of resulting elective procedures scheduled in a single year. Patients initially assessed at private consulting rooms are not included in this study. The number of surgical outpatient appointments issued in 2011 totalled 6503 with non-attendances running at 1489 (22.9%). The number of elective surgical theatre cases performed in 2011 (i.e. the surgical yield from that period) came to 1078 with an additional 1470 patients referred for endoscopy and 475 patients referred for minor operations. Operative surgical yield from the currently structured outpatient clinic model is low, with the number of theatre cases coming to only 16.58% of the original number of outpatient appointments issued. Recommendations for the improvement of outpatient services are made. These findings are relevant in the context of streamlining access to surgical services.

Estimating the need for dental sedation: evaluating the threshold of the IOSN tool in an adult population.

AIM: The aim of this study was, through a service evaluation, to assess the use of the IOSN tool in determining whether threshold values were appropriate for identification of IV sedation and general anaesthetic (GA) cases from a referral population. METHODS: A total of 105 patients were taken from a dental minor oral surgery referral service within a north west primary care trust over the course of six months. The IOSN tool was completed to assess: treatment complexity, medical and behavioural factors and patient anxiety levels. Each patient was then followed through to treatment. The type of sedation modality they received was compared to their IOSN score previously calculated and these results evaluated. RESULTS: The findings suggest that 94% of patients were treated within primary care by the MOS service, of which 58% received local anaesthetic (LA) alone and 42% were treated by LA with IV sedation. There was a general marked trend as the IOSN score increased so did the treatment modality from LA, through sedation to GA. Logistic regression using the components of the IOSN tool to predict sedation use indicated the IOSN predictors distinguished between those who required sedation and those who didn't (chi-square = 56.411, p <0.0001, df = 3) with treatment complexity (Exp B = 10.836, p <0.0001) and anxiety (Exp B = 4.319, p <0.0001) shown to be significant factors in determining sedation need. CONCLUSIONS: The data collected have shown that there is a positive relationship between the IOSN score and the type of treatment modality the patient received, suggesting that the threshold values are correctly set. It is concluded that IOSN tool is a useful means of aiding the clinician in both assessing and referring patients for that sedation need.

[Correlation between clinical and histological diagnosis in minor surgery in a rural health area]. / Correlación clínico-patológica en cirugía menor en un área de salud rural.

INTRODUCTION: Minor Surgery is an ever-increasing programmed activity in Primary Health Care Centres. The aim of this paper is to determine the relationship between the clinical diagnosis prior to Minor Surgery and its concordance with the histological results. MATERIAL AND METHODS: We carried out a retrospective study using the registered activity log in a Primary Health Care Centre in the region of Valdejalón of Aragón. SUBJECTS: A total of 1231 patients were included between April 1999 and June 2009. A total of 1391 diagnoses were given, together with the corresponding medical care. MEASUREMENTS: Clinical diagnosis and histological results, and the level of correlation between both. RESULTS: A total of 820 samples were submitted for histological study (59% of the total sample). Eleven of the main clinical and histological diagnoses were evaluated, and a contingency table was prepared. The result of the correlation gave a Kappa coefficient of 0.638. CONCLUSIONS: Once the results were analysed and compared to similar studies of Minor Surgery carried out in Primary Care, our results confirm that there is a high correlation between the clinical diagnosis and the histological results.

Correlación clínico-patológica en cirugía menor en un área de salud rural / Correlation between clinical and histological diagnosisv in minor surgery in a rural health area

Introducción. La cirugía menor forma parte de las actividades programadas en un número cada vez más creciente de nuestros centros de atención primaria. El objetivo de este trabajo es conocer el grado de correlación entre el diagnóstico clínico previo al proceso de cirugía menor y su concordancia con el resultado de anatomía patológica. Material y método. Para ello realizamos un estudio retrospectivo a partir del Registro de Actividades de Cirugía Menor de un Centro de Salud Rural de la Comarca de Valdejalón de Aragón. Sujetos. Se incluyeron 1.231 pacientes atendidos durante el periodo comprendido entre abril de 1999 y julio del año 2009 a los que se realizaron un total de 1.391 diagnósticos con sus correspondientes actuaciones. Mediciones. Diagnóstico clínico y resultado clínico-patológico. Correlaciones entre ambos Resultados Se remitieron 820 piezas para estudio clínico-patológico (el 59% de las intervenidas). Se valoraron los 11 diagnósticos clínicos y clínico-patológicos principales con los que se construyó una tabla de contingencia. Se obtuvo un coeficiente kappa de 0,638 Conclusiones. Analizados estos resultados y comparándolos con otros trabajos similares realizados en el ámbito de la cirugía menor en atención primaria, podemos afirmar que hay una buena correspondencia entre el diagnóstico clínico inicial y los resultados de anatomía patológica (AU)

Introduction. Minor Surgery is an ever-increasing programmed activity in Primary Health Care Centres. The aim of this paper is to determine the relationship between the clinical diagnosis prior to Minor Surgery and its concordance with the histological results. Material and methods. We carried out a retrospective study using the registered activity log in a Primary Health Care Centre in the region of Valdejalón of Aragón. Subjects. A total of 1231 patients were included between April 1999 and June 2009. A total of 1391 diagnoses were given, together with the corresponding medical care. Measurements. Clinical diagnosis and histological results, and the level of correlation between both. Results. A total of 820 samples were submitted for histological study (59% of the total sample). Eleven of the main clinical and histological diagnoses were evaluated, and a contingency table was prepared. The result of the correlation gave a Kappa coefficient of 0.638. Conclusions. Once the results were analysed and compared to similar studies of Minor Surgery carried out in Primary Care, our results confirm that there is a high correlation between the clinical diagnosis and the histological results (AU)

A five-year evaluation of an NHS dental practice-based specialist minor oral surgery service.

OBJECTIVE: To report the findings of an evaluation of an NHS dental practice-based minor oral surgery service. BASIC RESEARCH DESIGN: Service evaluation. CLINICAL SETTING: NHS specialist practice in England. PARTICIPANTS: Patients and referring practitioners. INTERVENTIONS: analysis of activity, patient and referring practitioner satisfaction data. MAIN OUTCOME MEASURES: Numbers and case-mix treated; non-attendance; antibiotic prescribing; complication rates; patients and referring practitioner satisfaction. RESULTS: 5,796 treatment appointments were arranged, with a median waiting time from receipt of referral to treatment of 35 days. Treatment provided included: surgical removal of third molars and non-third molars, surgical endodontics and other surgical and oral medicine cases (28.3%, 53.3%, 3.5%, and 15.0% of cases, respectively). Antibiotics were prescribed at 13.1% of all treatment appointments and 2.5% required appointments for post-operativecomplications. All but one patient reported overall satisfaction and over 98% strongly agreed/agreed with positive attitudinal statements about the oral surgeon's communication/information giving, technical competence and understanding/acceptance. 70.1% of patients were seen on time and under 1% were seen more than 15 minutes late. Some 83.1% felt the standard of service was better than expected from a hospital and none felt it was worse. More than 85% of referring practitioners agreed that: waiting times were shorter than at the hospital; urgent problems were seen quickly; and, the referral process was easy and understandable. Over 98% either strongly agreed or agreed that they were happy with the service provided. CONCLUSIONS: A range of minor oral surgery procedures can be provided with low complication rates, short waiting times, acceptable accessibility and high levels of patient and referring practitioner satisfaction from a specialist NHS dental practice-based service.

Cirugía menor en un centro de salud familiar y concordancia clínico patológica / Minor surgery in a family health center and clinicopathological concordance

INTRODUCCIÓN: Los servicios de Atención Primaria de Salud(APS) realizan Cirugía Menor(CM), evidenciándose beneficios como optimización de recursos y promoción de la actividad preventiva, diagnóstica y terapéutica. OBJETIVO: Describir la actividad de CM en un centro de APS y analizar la concordancia clínica-patológica de las lesiones...

INTRODUCTION: Primary Health Care (PHM) services perform minor surgery (MS), displaying benefits such as resource optimization and the promotion of preventive, diagnostic and therapeutic activities. OBJECTIVE: Describe the MS activity from a PHM center and analyse the clinicopathological concordance of the lesions…

A baseline audit of referral and treatment delivered to patients in the intermediate minor oral surgery service in Croydon PCT.

INTRODUCTION: Patients attending for primary dental care may require oral surgery procedures beyond the capability of a generalist and thus need to be treated by a dentist with greater expertise. In the United Kingdom, it is increasingly accepted that such care may be provided in primary care settings by specialists or dentists with a special interest. In response to local pressures, an intermediate minor oral surgery (IMOS) service has been established in Croydon, south west London, to provide oral surgery treatment for non-urgent patients on referral. AIM: To audit the appropriateness and quality of oral surgery referrals after triage to an IMOS service in Croydon and to set standards for future audits on this topic. METHODS: An audit tool was developed in line with the local referral guidelines and agreed with local stakeholders. Information on 501 (10%) triaged referrals to IMOS practices over a 24-month period was obtained through the referral management centre. A 10% sample of referrals per month to each practice was calculated and IMOS providers randomly selected the relevant patient records. Using an agreed audit pro forma, information on the indications for referral, treatment provided, and dates relating to patient management, in addition to the age and sex of patients, was collected from the IMOS providers by one investigator. Descriptive analysis of the data was performed. RESULTS: Of the 501 patient records that were examined, 99% of patients were treated in IMOS practices, with only three (less than 1%) patients being referred on to hospital consultant services. The largest proportion (237; 40%) of referrals was for the extraction of teeth considered to have special difficulty, followed by lower third molars (154; 26%). Almost one-third (159; 32%) of patients were referred for more than one procedure. One in eight (72; 13%) teeth removed by the IMOS providers were recorded as a simple extraction without medical complications. CONCLUSIONS: In general, patients were referred appropriately to the primary care oral surgery service in Croydon, with only a minority recorded as receiving simple care that should not have required referral. The clinician-led triage process using a referral management system worked well in selecting appropriate patients for treatment by IMOS providers in primary care and reduced referrals to hospital. Suggested standards for future audits of IMOS referrals have been set.

Cirugía menor, ¿satisfacción y calidad? / Minor surgery: satisfaction and quality?

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Safety of bevacizumab in metastatic breast cancer patients undergoing surgery.

BACKGROUND: Evaluate the safety of surgery in relation to bevacizumab in the first-line treatment of metastatic breast cancer (mBC) in two international trials. PATIENTS AND METHODS: The incidence, type and timing of post-surgical bleeding events and wound-healing complications were assessed in surgical patients in the AVastin And DOcetaxel (AVADO) (NCT00333775) and Avastin THErapy for advaNced breAst cancer (ATHENA) (NCT00448591) trials. Both study protocols followed recommendations to withhold bevacizumab for at least 6 weeks before elective surgery and to wait 28 days (or until the wound was fully healed) after major surgery before recommencing bevacizumab therapy. RESULTS: In AVADO, 221 surgical procedures (55 major, 166 minor) were performed in 155 patients. In ATHENA, 1190 surgical procedures (435 major, 755 minor) were performed in 672 patients. One bevacizumab-treated AVADO patient (0.9%) who underwent surgery experienced a grade 3 bleeding event. In ATHENA, six patients (0.9%) who underwent surgery experienced grade 3 bleeding events and one patient (0.1%) experienced a grade 4 bleeding event. No grade 5 bleeding events in patients undergoing surgery were reported in either study. One grade 3 wound-healing complication was reported in each of the AVADO arms: placebo (n=46, 2.2%), bevacizumab 7.5mg/kg (n=57, 1.8%) and bevacizumab 15mg/kg (n=52, 1.9%). Incidence of grade 3-4 wound-healing complications in ATHENA was 2.2% and 1.3% in patients undergoing minor or major surgery, respectively. CONCLUSIONS: Surgery can be performed on patients with mBC undergoing bevacizumab therapy with a low risk of severe bleeding or wound-healing complications post surgery, if current labelling recommendations are adhered to.

Postoperative infection after excisional toenail matrixectomy: a retrospective clinical audit.

BACKGROUND: Excisional toenail matrixectomies are performed on the area of the foot that has been reported to have the highest concentration of resident microorganisms. A retrospective infection audit was performed to identify whether this unique area of the foot was more susceptible to postoperative infection. METHODS: A retrospective audit reviewing the postoperative infection rate over a 6-year period after excisional nail matrixectomy in 111 patients was undertaken. RESULTS: The postoperative infection rate was found to be high (18.9%) relative to that of clean orthopedic foot and ankle surgery (0.5%-6.5%). CONCLUSIONS: The unique concentration of resident microbes found in the nail folds could help explain the high rate of postoperative infections identified in this study. This may provide some argument to classify excisional nail matrixectomy as clean-contaminated surgery and, thus, warrant routine antibiotic prophylaxis. Further research is recommended to confirm the results of this study and to determine whether appropriately timed oral antibiotic prophylaxis will reduce the infection rate after nail surgery.