Impact of lockdown for SARS-CoV-2 (COVID-19) on surgical site infection rates: a monocentric observational cohort study.

Surgical site infections are the most common in-hospital acquired infections. The aim of this study and the primary endpoint is to evaluate how the measures to reduce the SARS-CoV-2 spreading affected the superficial and deep SSI rate. A total of 541 patients were included. Of those, 198 from March to April 2018, 220 from March till April 2019 and 123 in the COVID-19 era from March to April 2020. The primary endpoint occurred in 39 over 541 patients. In COVID-19 era, we reported a lower rate of global SSIs (3.3% vs. 8.4%; p 0.035), few patients developed a superficial SSIs (0.8% vs. 3.4%; p 0.018) and none experienced deep SSIs (0% vs. 3.4%; p 0.025). Comparing the previous two "COVID-19-free" years, no significative differences were reported. At multivariate analysis, the measures to reduce the SARS-CoV-2 spread (OR 0.368; p 0.05) were independently associated with the reduction for total, superficial and deep SSIs. Moreover, the presence of drains (OR 4.99; p 0.009) and a Type III-IV of SWC (OR 1.8; p 0.001) demonstrated a worse effect regarding the primary endpoint. Furthermore, the presence of the drain was not associated with an increased risk of superficial and deep SSIs. In this study, we provided important insights into the superficial and deep SSIs risk assessment for patients who underwent surgery. Simple and easily viable precautions such as wearing surgical masks and the restriction of visitors emerged as promising tools for the reduction of SSIs risk.

[Evaluation of surgical risk in elderly patients: a review of 207 cases]. / La valutazione del rischio operatorio nel paziente anziano: revisione di 207 casi.

Thorough evaluation of surgical risk represents the sine qua non for a correct therapeutic choice particularly in the elderly who are frequently affected by multiple pathologies. The aim of this study was to evaluate the prognostic value of two of the most common classification systems for predicting surgical risk (ASA and Reiss scores) and of other laboratory parameters. A consecutive series of 207 patients aged 70 or above were analysed retrospectively, considering age, ASA and Reiss scores, elective or emergency surgery, operative time, leucocytes, haemoglobin, creatinine, and albumin levels. Morbidity and mortality rates were compared in relation to these parameters. Emergency surgery was associated with significantly higher morbidity (P = 0.006 chi-square) and mortality (P = 0.001 chi-square) than elective surgery. No differences in morbidity were noted in association with the ASA classification (P = 0.07 chi-square), though there was a significant difference (P = 0.001 chi-square) in mortality. Significant differences in both morbidity (P = 0.04 chi-square) and mortality (P = 0.001 chi-square) were found to be associated with the Reiss classification. Multivariate analysis showed that ASA score (P = 0.006), Reiss score (P = 0.004), operative time (P = 0.005), and haemoglobin level (P = 0.01) were independent prognostic factors. The results of the study confirm the prognostic value of multiparametric classifications such as the ASA and Reiss score in elderly patients, even if the addition of other prognostic factors may be expected to improve the sensitivity.

[Treatment of adenocarcinoma of the duodenum: presentation of 4 clinical cases and review of the literature]. / Trattamento dell'adenocarcinoma del duodeno: presentazione di quattro casi clinici e revisione della letteratura.

The Authors comment on the difficulty of diagnosing and treating duodenal tumours. The most appropriate indications and extent of resection of these neoplasms are discussed. The Authors report 4 cases of primitive adenocarcinoma of the duodenum treated by pancreaticoduodenectomy (2 cases), segmental resection (1 case) and palliative surgery (1 case) for the presence of omental and lymph-node metastases. Survival was 18 and 14 months in the patients who underwent pancreaticoduodenectomy and 9 months for the patient receiving palliative treatment; the patient who underwent segmental resection is still alive and healthy after 12 months. The Authors point out that adenocarcinoma of the duodenum is an uncommon neoplasm and stress the difficulty encountered in establishing an accurate diagnosis and appropriate surgical management. Better results can be obtained only with an early diagnosis. Chemotherapy and radiotherapy do not significantly improve survival.