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Adam YA, Hajibandeh S, Abdelrahman A, Neary PM. Effect of Pulsed Lavage on Surgical Site Infection in Abdominal Surgery: A Systematic Review and Meta-Analysis. Am Surg 2025:31348251338737. [PMID: 40286037 DOI: 10.1177/00031348251338737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2025]
Abstract
Objective: To evaluate the effect of pulsed lavage on the risk of surgical site infection in patients undergoing abdominal. Methods: A systematic review and meta-analysis was conducted in compliance with PRISMA statement standards. We evaluated all studies comparing pulsed lavage and standard practice in patients undergoing abdominal surgery. Surgical site infection was the outcome measure. Random-effects modeling was applied for the analyses. The certainty of the evidence was assessed using the grade system. Results: Five studies including 747 patients were included. The operations in both groups were comparable in terms of elective (RD: 0.00, 95% CI -0.02-0.03, P = 0.85) or emergency setting (RD: -0.00, 95% CI -0.03-0.02, P = 0.85) and open (RD: 0.00, 95% CI -0.02-0.02, P = 0.94) or laparoscopic approach (RD: -0.00, 95% CI -0.02-0.02, P = 0.94). Pulsed lavage was associated with a reduced risk of surgical site infection compared with no pulsed lavage (OR: 0.31, 95% CI 0.20-0.48, P < 0.00001). The between-study heterogeneity was low (I2 = 0%), and the grade certainty was high. The results were consistent through subgroup analysis of randomized controlled trials (OR: 0.28, 95% CI 0.15-0.52, P < 0.0001), observational studies (OR: 0.35, 95% CI 0.19-0.64, P = 0.0007), patients undergoing elective operation (OR: 0.31, 95% CI 0.16-0.62, P = 0.0009), emergency operation (OR: 0.28, 95% CI 0.14-0.58, P = 0.0006), and open operation (OR: 0.30, 95% CI 0.16-0.55, P = 0.0001). Conclusions: Robust evidence suggests that pulsed lavage reduces the risk of surgical site infection in patients undergoing abdominal surgery. We do not hesitate to recommend the routine use of pulsed lavage in abdominal surgery in both emergency and elective settings.
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Affiliation(s)
- Yousif Abdallah Adam
- Vascular Surgery, Wales Denary, Health Education, and Improvement Wales, Nantgarw, UK
| | - Shahab Hajibandeh
- General Surgery, Wales Deanery, Health Education and Improvement Wales, Nantgarw, UK
| | | | - Peter M Neary
- Department of Academic Surgery, University Hospital Waterford, University College Cork School of Medicine, Cork, Ireland
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2
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Provenzano DA, Hanes M, Hunt C, Benzon HT, Grider JS, Cawcutt K, Doshi TL, Hayek S, Hoelzer B, Johnson RL, Kalagara H, Kopp S, Loftus RW, Macfarlane AJR, Nagpal AS, Neuman SA, Pawa A, Pearson ACS, Pilitsis J, Sivanesan E, Sondekoppam RV, Van Zundert J, Narouze S. ASRA Pain Medicine consensus practice infection control guidelines for regional anesthesia and pain medicine. Reg Anesth Pain Med 2025:rapm-2024-105651. [PMID: 39837579 DOI: 10.1136/rapm-2024-105651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 08/27/2024] [Indexed: 01/23/2025]
Abstract
BACKGROUND To provide recommendations on risk mitigation, diagnosis and treatment of infectious complications associated with the practice of regional anesthesia, acute and chronic pain management. METHODS Following board approval, in 2020 the American Society of Regional Anesthesia and Pain Medicine (ASRA Pain Medicine) commissioned evidence-based guidelines for best practices for infection control. More than 80 research questions were developed and literature searches undertaken by assigned working groups comprising four to five members. Modified US Preventive Services Task Force criteria were used to determine levels of evidence and certainty. Using a modified Delphi method, >50% agreement was needed to accept a recommendation for author review, and >75% agreement for a recommendation to be accepted. The ASRA Pain Medicine Board of Directors reviewed and approved the final guidelines. RESULTS After documenting the incidence and infectious complications associated with regional anesthesia and interventional pain procedures including implanted devices, we made recommendations regarding the role of the anesthesiologist and pain physician in infection control, preoperative patient risk factors and management, sterile technique, equipment use and maintenance, healthcare setting (office, hospital, operating room), surgical technique, postoperative risk reduction, and infection symptoms, diagnosis, and treatment. Consensus recommendations were based on risks associated with different settings and procedures, and keeping in mind each patient's unique characteristics. CONCLUSIONS The recommendations are intended to be multidisciplinary guidelines for clinical care and clinical decision-making in the regional anesthesia and chronic interventional pain practice. The issues addressed are constantly evolving, therefore, consistent updating will be required.
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Affiliation(s)
| | - Michael Hanes
- Jax Spine and Pain Centers, Jacksonville, Florida, USA
| | - Christine Hunt
- Anesthesiology-Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Honorio T Benzon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Pain Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Jay S Grider
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
| | - Kelly Cawcutt
- Division of Infectious Diseases and Pulmonary & Critical Care Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tina L Doshi
- Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Pain Medicine, John Hopkins University, Baltimore, Maryland, USA
- Department of Neurosurgery, John Hopkins University, Baltimore, Maryland, USA
| | - Salim Hayek
- Anesthesiology, Case Western Reserve University, Cleveland, Ohio, USA
- University Hospitals of Cleveland, Cleveland, Ohio, USA
| | | | - Rebecca L Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Sandra Kopp
- Anesthesiology, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Randy W Loftus
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ameet S Nagpal
- Department of Orthopaedics and Physical Medicine & Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie A Neuman
- Department of Pain Medicine, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Amit Pawa
- Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- King's College London, London, UK
| | - Amy C S Pearson
- Anesthesia, Advocate Aurora Health Inc, Milwaukee, Wisconsin, USA
| | | | - Eellan Sivanesan
- Neuromodulation, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rakesh V Sondekoppam
- Department of Anesthesia, Pain, and Perioperative Medicine, Stanford University, Palo Alto, California, USA
| | - Jan Van Zundert
- Anesthesiology and Pain Medicine, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
- Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Samer Narouze
- Division of Pain Management, University Hospitals, Cleveland, Ohio, USA
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Kwon DY, Shamamiam P, Kim E, Genet S, Gyasi A, Gallate Z, Seyidova N, Oleru O, Henderson PW. Pulse Irrigation Reduces Rate of Postoperative Hematoma Following Breast Reduction. Aesthetic Plast Surg 2025:10.1007/s00266-025-04682-6. [PMID: 39838127 DOI: 10.1007/s00266-025-04682-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Accepted: 01/06/2025] [Indexed: 01/23/2025]
Abstract
PURPOSE Breast reduction (BR) involves a large surface area of manipulated tissue, increasing the risk of postoperative hematoma. Pulse irrigation (PI) uses a device to deliver intermittent pressurized irrigant intraoperatively. This study aims to evaluate whether the use of PI is associated with reduced incidence of postoperative hematoma after BR. METHODS An IRB-approved, retrospective cohort study was performed on all female patients >18 years old who underwent BR at a single academic medical center from 2019 to 2023. Patients operated on by surgeons who performed BR exclusively with or exclusively without PI were excluded. Demographics, surgical details, and postoperative complications were compared using T-tests for independent samples and Pearson chi-square tests of significance (statistical significance set at p<0.05). RESULTS A total of 418 patients met inclusion and exclusion criteria: 196 PI patients (46.9%) and 222 (53.1%) non-PI patients. PI patients had differences in race, type of insurance and higher usage of liposuction (all p<0.001). There was a statistically significantly lower hematoma rate in PI patients compared to non-PI patients (0.0% vs. 2.7%, p=0.020). Although not statistically significant, PI patients had lower rates of seroma (1.0% vs. 3.6%, p=0.085) and superficial incisional SSI (1.5% vs. 2.7%, p=0.410) than non-PI patients. CONCLUSION Intraoperative use of PI reduces the rate of postoperative hematoma in patients undergoing BR. This finding is hypothesized to be due to provocative disruption of unstable clots which thereby helps to identify sites of tenuous hemostasis so that they can be better cauterized prior to completion of the procedure. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Daniel Y Kwon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Peter Shamamiam
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Esther Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Simeret Genet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Abena Gyasi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Zachary Gallate
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Nargiz Seyidova
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Olachi Oleru
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA
| | - Peter W Henderson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, 10 Union Square East, Suite 2L, New York, 10003, USA.
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Takeda M, Morita Y, Akai T, Murakami T, Booka E, Matsumoto T, Katahashi K, Takaoka M, Kikuchi H, Hiramatsu Y, Inuzuka K, Kurachi K, Takeuchi H. Effects of povidone-iodine wound irrigation on surgical site infection in gastroenterological surgery: A randomized controlled trial. Surgery 2024; 176:371-378. [PMID: 38825398 DOI: 10.1016/j.surg.2024.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The irrigation efficacy of a povidone-iodine solution to prevent surgical site infection is still controversial. We assessed the irrigation effect with a povidone-iodine solution on the incidence of surgical site infection after gastroenterological surgery. METHODS This study is a single-center, prospective, randomized, blinded-end point superiority trial for surgical wound irrigation. Patients undergoing gastroenterological surgery were randomly assigned in a 1:1 replacement ratio using computer-generated randomization. Patients were grouped according to their surgical wound treatment into the control group using the normal sterile saline and the povidone-iodine group using 10% povidone-iodine solution after the NS solution. The main finding was 30-day surgical site infections assessed in the full analysis set. RESULTS From November 2020 to December 2022, 697 of 894 patients were eligible for the study, among which 347 were in the povidone-iodine group and 350 in the control group. Thirty-day surgical site infections occurred in 100 (14%) patients-54 (16%) in the povidone-iodine group and 46 (13%) in the control group (odds ratio, 1.229; 95% CI, 0.800-1.889; P = .406). Superficial incisional surgical site infections occurred in 30 (9%) and 15 (4%) patients, respectively (odds ratio, 2.154; 95% CI, 1.134-4.090; P = .026). Only 3 patients (1%) in the control group developed adverse skin reactions. CONCLUSION This study examined the irrigation efficacy of povidone-iodine for surgical site infection prevention compared to control in gastroenterological surgery. Povidone-iodine wound irrigation has shown no additional beneficial effect on the occurrence of surgical site infections.
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Affiliation(s)
- Makoto Takeda
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiya Akai
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Murakami
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Eisuke Booka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuto Katahashi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masayo Takaoka
- Data Ops Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazunori Inuzuka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyotaka Kurachi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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5
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Frassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, et alFrassini S, Cobianchi L, Fugazzola P, Biffl WL, Coccolini F, Damaskos D, Moore EE, Kluger Y, Ceresoli M, Coimbra R, Davies J, Kirkpatrick A, Di Carlo I, Hardcastle TC, Isik A, Chiarugi M, Gurusamy K, Maier RV, Segovia Lohse HA, Jeekel H, Boermeester MA, Abu-Zidan F, Inaba K, Weber DG, Augustin G, Bonavina L, Velmahos G, Sartelli M, Di Saverio S, Ten Broek RPG, Granieri S, Dal Mas F, Farè CN, Peverada J, Zanghì S, Viganò J, Tomasoni M, Dominioni T, Cicuttin E, Hecker A, Tebala GD, Galante JM, Wani I, Khokha V, Sugrue M, Scalea TM, Tan E, Malangoni MA, Pararas N, Podda M, De Simone B, Ivatury R, Cui Y, Kashuk J, Peitzman A, Kim F, Pikoulis E, Sganga G, Chiara O, Kelly MD, Marzi I, Picetti E, Agnoletti V, De'Angelis N, Campanelli G, de Moya M, Litvin A, Martínez-Pérez A, Sall I, Rizoli S, Tomadze G, Sakakushev B, Stahel PF, Civil I, Shelat V, Costa D, Chichom-Mefire A, Latifi R, Chirica M, Amico F, Pardhan A, Seenarain V, Boyapati N, Hatz B, Ackermann T, Abeyasundara S, Fenton L, Plani F, Sarvepalli R, Rouhbakhshfar O, Caleo P, Ho-Ching Yau V, Clement K, Christou E, Castillo AMG, Gosal PKS, Balasubramaniam S, Hsu J, Banphawatanarak K, Pisano M, Adriana T, Michele A, Cioffi SPB, Spota A, Catena F, Ansaloni L. ECLAPTE: Effective Closure of LAParoTomy in Emergency-2023 World Society of Emergency Surgery guidelines for the closure of laparotomy in emergency settings. World J Emerg Surg 2023; 18:42. [PMID: 37496068 PMCID: PMC10373269 DOI: 10.1186/s13017-023-00511-w] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023] Open
Abstract
Laparotomy incisions provide easy and rapid access to the peritoneal cavity in case of emergency surgery. Incisional hernia (IH) is a late manifestation of the failure of abdominal wall closure and represents frequent complication of any abdominal incision: IHs can cause pain and discomfort to the patients but also clinical serious sequelae like bowel obstruction, incarceration, strangulation, and necessity of reoperation. Previous guidelines and indications in the literature consider elective settings and evidence about laparotomy closure in emergency settings is lacking. This paper aims to present the World Society of Emergency Surgery (WSES) project called ECLAPTE (Effective Closure of LAParoTomy in Emergency): the final manuscript includes guidelines on the closure of emergency laparotomy.
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Affiliation(s)
- Simone Frassini
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy.
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
| | - Lorenzo Cobianchi
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Paola Fugazzola
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Walter L Biffl
- Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Dimitrios Damaskos
- General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Marco Ceresoli
- General Surgery, Monza University Hospital, Monza, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC, Claremont, CA, USA
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Calgary, Canada
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Unit, Cannizzaro Hospital, Catania, Italy
| | - Timothy C Hardcastle
- Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa
- Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Pisa, Italy
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional Science, Hampstead Campus, University College London, London, UK
| | - Ronald V Maier
- Department of Surgery, Harborview Medical Centre, University of Washington, Seattle, USA
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Hans Jeekel
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marja A Boermeester
- Department of Surgery, Amsterdam University Medical Center, University of Amsterdam, 1105AZ, Amsterdam, The Netherlands
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE
| | - Kenji Inaba
- Los Angeles County + USC Medical Center, 2051 Marengo Street, Room C5L100, Los Angeles, CA, 90033, USA
| | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Goran Augustin
- Department of Surgery, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Luigi Bonavina
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, Milan, Italy
| | - George Velmahos
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Salomone Di Saverio
- Unit of General Surgery, San Benedetto del Tronto Hospital, av5 Asur Marche, San Benedetto del Tronto, Italy
| | | | - Stefano Granieri
- General Surgery Unit, ASST Vimercate, Via Santi Cosma E Damiano, 10, 20871, Vimercate, Italy
| | - Francesca Dal Mas
- Department of Management, Università Ca' Foscari, Dorsoduro 3246, 30123, Venezia, Italy
| | - Camilla Nikita Farè
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Peverada
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Simone Zanghì
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Jacopo Viganò
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Matteo Tomasoni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Tommaso Dominioni
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Enrico Cicuttin
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Giovanni D Tebala
- Department of Digestive and Emergency Surgery, S. Maria Hospital Trust, Terni, Italy
| | - Joseph M Galante
- Trauma Department, University of California, Davis, Sacramento, CA, USA
| | | | - Vladimir Khokha
- Department of Emergency Surgery, City Hospital, Mozyr, Belarus
| | - Michael Sugrue
- Donegal Clinical Research Academy Emergency Surgery Outcome Project, Letterkenny University Hospital, Donegal, Ireland
| | - Thomas M Scalea
- Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD, USA
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark A Malangoni
- Department of Surgery, MetroHealth Medical Center Campus, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Nikolaos Pararas
- Third Department of Surgery, Attikon University Hospital, 15772, Athens, Greece
| | - Mauro Podda
- Department of Surgical Science, Cagliari State University, Cagliari, Italy
| | - Belinda De Simone
- Department of Emergency Surgery, Centre Hospitalier Intercommunal de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
| | - Rao Ivatury
- Virginia Commonwealth University, Richmond, VA, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Jeffry Kashuk
- Department of Surgery, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Andrew Peitzman
- Division of Trauma and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Fernando Kim
- Denver Health Medical Center, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emmanouil Pikoulis
- Medical School, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A.Gemelli IRCCS, Università Cattolica, Rome, Italy
| | - Osvaldo Chiara
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michael D Kelly
- Department of General Surgery, Albury Hospital, Albury, Australia
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, Ospedale M Bufalini, Cesena, Italy
| | - Nicola De'Angelis
- Service de Chirurgie Digestive et Hépato-Bilio-Pancréatique, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Giampiero Campanelli
- Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Insubria, Varese, Italy
| | - Marc de Moya
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrey Litvin
- AI Medica Hospital Center / Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Aleix Martínez-Pérez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Ibrahima Sall
- Department of General Surgery, Military Teaching Hospital, Hôpital Principal Dakar, Dakar, Senegal
| | | | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Philip F Stahel
- Department of Orthopedic Surgery and Neurosurgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Ian Civil
- Trauma Service, Auckland City Hospital, Auckland, New Zealand
| | | | - David Costa
- Department of General y Digestive Surgery, "Dr. Balmis" Alicante General University Hospital, Alicante, Spain
| | | | - Rifat Latifi
- College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Mircea Chirica
- Service de Chirurgie Digestive, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Francesco Amico
- Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | | | - Vidya Seenarain
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Nikitha Boyapati
- Acute Surgical Unit, Department of General Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Basil Hatz
- State Major Trauma Unit, Royal Perth Hospital, Wellington Street, Perth, Australia
| | - Travis Ackermann
- General Surgery, Monash Medical Centre, Monash Health, Melbourne, VIC, Australia
| | - Sandun Abeyasundara
- Department of Colorectal Surgery, Logan Hospital, Meadowbrook, QLD, Australia
| | - Linda Fenton
- Maitland Private Hospital, East Maitland, Newcastle, NSW, Australia
| | - Frank Plani
- Chris Hani Baragwanath Hospital, Soweto, South Africa
| | - Rohit Sarvepalli
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Omid Rouhbakhshfar
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Pamela Caleo
- Nambour Selangor Private Hospital, Sunshine Coast University Private Hospital, Birtinya, QLD, Australia
| | | | - Kristenne Clement
- Department of Surgery, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Erasmia Christou
- Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | | | - Preet K S Gosal
- Department of General Surgery, Nepean Hospital, Sydney, NSW, Australia
| | - Sunder Balasubramaniam
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Michele Pisano
- General and Emergency Surgery, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Toro Adriana
- General Surgery, Augusta Hospital, Augusta, Italy
| | - Altomare Michele
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Stefano P B Cioffi
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Spota
- Trauma Center and Emergency Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fausto Catena
- Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy
| | - Luca Ansaloni
- University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy
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6
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Luck T, Zaki P, Michels R, Slotkin EM. The Cost-Effectiveness of Normal-Saline Pulsed Lavage for Infection Prophylaxis in Total Joint Arthroplasty. Arthroplast Today 2022; 18:107-111. [PMID: 36304695 PMCID: PMC9593269 DOI: 10.1016/j.artd.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Prosthetic joint infection (PJI) is a well-described complication after total joint arthroplasty which imposes a substantial burden of morbidity and mortality on the individual, as well as cost to the health-care system. This study used a break-even analysis to investigate the cost-effectiveness of pulsed saline lavage (PSL) for PJI prophylaxis after a primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods An established model was used to calculate the minimum cost-effective absolute risk reduction of PSL for infection prophylaxis after a total joint arthroplasty. Baseline infection rates of TKA and THA and the cost of a revision surgery for PJI were derived from the literature while the cost of PSL implementation was obtained from institutional data. Results PSL is cost-effective at an initial infection rate of 1.10%, revision costs of $32,132 for TKA PJI, and a protocol cost of $38.28 if it reduces infection rates by 0.12% or prevents infection in 1 out of 839 patients. PSL is cost-effective at an initial infection rate of 1.63% and a revision cost of $39,713 for THA PJI if it reduces infection rates by 0.10% or prevents infection in 1 out of 1037 patients. The absolute risk reduction needed for economic viability did not change with varying baseline infection rates and did not exceed 0.38% for infection treatment costs as low as $10,000 and remained less than 0.47% even if PSL cost was as high as $150. Conclusions The use of PSL is a cost-effective protocol for PJI prophylaxis after TKAs and THAs.
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Affiliation(s)
- Trevor Luck
- Drexel University College of Medicine, Philadelphia, Pennsylvania,Corresponding author. Drexel University College of Medicine, 613 Sandstone Drive, Wyomissing, PA 19610, USA. Tel.: +1 207 590 8513.
| | - Peter Zaki
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ryan Michels
- Reading Hospital, Orthopaedic Associates of Reading, Wyomissing, Pennsylvania
| | - Eric M. Slotkin
- Reading Hospital, Orthopaedic Associates of Reading, Wyomissing, Pennsylvania
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7
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Bath MF, Suresh R, Davies J, Machesney MR. Does pulsed lavage reduce the risk of surgical site infection? A systematic review and meta-analysis. J Hosp Infect 2021; 118:32-39. [PMID: 34454976 DOI: 10.1016/j.jhin.2021.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) remain a significant and common postoperative complication. Whereas most surgeons use some form of wound irrigation during closure, its impact on SSI rates is debated. Preliminary studies in the use of pressurized irrigation, termed pulsed lavage, may have potential benefit to reduce the risk of SSI. AIM To perform a systematic review to identify studies that reported SSI rates following surgery, comparing the use of pulsed lavage to controls, following PRISMA guidelines. METHODS All study types and those published up to January 1st, 2021 were included. Odds ratios (ORs) were calculated for each included study using a Mantel-Haenszel statistical analysis, via a random effects model. A sub-analysis on abdominal procedures only was also performed. FINDINGS Eleven studies met the inclusion criteria, covering either orthopaedic or general surgery procedures; 1875 patients were included, with 816 patients in the pulsed lavage group and 1059 patients in the control group. Overall study quality was low. There was a significant reduction in the SSI rate with the use of pulsed lavage (odds ratio (OR): 0.39; 95% confidence interval (CI): 0.25-0.62; P < 0.0001). Sub-analysis on abdominal operations only showed further improvement to the SSI rate with pulsed lavage (OR: 0.32; 95% CI: 0.21-0.49; P < 0.0001). CONCLUSION Pulsed lavage significantly reduces the rate of SSIs in surgical procedures, the effect being most pronounced in abdominal operations; however, current study quality is low. Randomized controlled trial data are essential to fully assess the potential clinical and financial benefits pulsed lavage can confer to SSI reduction.
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Affiliation(s)
- M F Bath
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
| | - R Suresh
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - J Davies
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
| | - M R Machesney
- Department of Surgery, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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8
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Papadakis M. Wound irrigation for preventing surgical site infections. World J Methodol 2021; 11:222-227. [PMID: 34322371 PMCID: PMC8299912 DOI: 10.5662/wjm.v11.i4.222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/06/2021] [Accepted: 06/25/2021] [Indexed: 02/06/2023] Open
Abstract
Wound irrigation (i.e. washing out a wound before wound closure) aims to reduce the microbial burden by removing tissue debris, metabolic waste, and tissue exudate from the surgical field before site closure. Although it is a popular procedure in every day surgical practice, the lack of procedure standardization, leads to studies with high heterogeneity and often controversial results. Thus, there are studies that advocate its use, while others discourage its implementation in clinical practice to reduce the risk of surgical site infection. The present article reviews the current literature on wound irrigation for preventing surgical site infections. Several irrigants are presented. Chlorexidine is generally considered to be less effective than povidone-iodine, while antibiotics are not that common nowadays, as they require prolonged exposure with the target to act. Hydrogen peroxide has several potential complications, which eliminate its use. Any differences in the incidence of surgical site infections between different irrigants, especially between antibacterial and non-bacterial ones, should be viewed sceptically. More randomized controlled studies are needed to provide better quality of evidence regarding the irrigants' effectiveness and safety.
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Affiliation(s)
- Marios Papadakis
- Department of Surgery II, University of Witten-Herdecke, Wuppertal 42283, Germany
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9
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Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy. J Surg Res 2021; 266:300-305. [PMID: 34038852 DOI: 10.1016/j.jss.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/01/2021] [Accepted: 04/10/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Surgical site infections (SSI) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is predominantly limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies. METHODS Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following strengthening the reporting of observational studies in epidemiology (STROBE) criteria. The primary outcome was rate of superficial SSI within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis. RESULTS 176 patients were identified, with an average age of 60.7 ± 19.1 y. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty-two patients (29.5%) had PL used during their operation. Thirty-seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (P = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, P= 0.047) for developing a SSI. CONCLUSION PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.
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10
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Ohge H, Mayumi T, Haji S, Kitagawa Y, Kobayashi M, Kobayashi M, Mizuguchi T, Mohri Y, Sakamoto F, Shimizu J, Suzuki K, Uchino M, Yamashita C, Yoshida M, Hirata K, Sumiyama Y, Kusachi S. The Japan Society for Surgical Infection: guidelines for the prevention, detection, and management of gastroenterological surgical site infection, 2018. Surg Today 2021; 51:1-31. [PMID: 33320283 PMCID: PMC7788056 DOI: 10.1007/s00595-020-02181-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The guidelines for the prevention, detection, and management of gastroenterological surgical site infections (SSIs) were published in Japanese by the Japan Society for Surgical Infection in 2018. This is a summary of these guidelines for medical professionals worldwide. METHODS We conducted a systematic review and comprehensive evaluation of the evidence for diagnosis and treatment of gastroenterological SSIs, based on the concepts of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The strength of recommendations was graded and voted using the Delphi method and the nominal group technique. Modifications were made to the guidelines in response to feedback from the general public and relevant medical societies. RESULTS There were 44 questions prepared in seven subject areas, for which 51 recommendations were made. The seven subject areas were: definition and etiology, diagnosis, preoperative management, prophylactic antibiotics, intraoperative management, perioperative management, and wound management. According to the GRADE system, we evaluated the body of evidence for each clinical question. Based on the results of the meta-analysis, recommendations were graded using the Delphi method to generate useful information. The final version of the recommendations was published in 2018, in Japanese. CONCLUSIONS The Japanese Guidelines for the prevention, detection, and management of gastroenterological SSI were published in 2018 to provide useful information for clinicians and improve the clinical outcome of patients.
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Affiliation(s)
- Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan.
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Seiji Haji
- Department of Surgery, Soseikai General Hospital, Kyoto, Japan
| | - Yuichi Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Masahiro Kobayashi
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Tokyo, Japan
| | - Motomu Kobayashi
- Perioperative Management Center, Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Toru Mizuguchi
- Division of Surgical Science, Department of Nursing, Sapporo Medical University, Sapporo, Japan
| | - Yasuhiko Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Mie, Japan
| | - Fumie Sakamoto
- Infection Control Division, Quality Improvement Center, St. Luke's International Hospital, Tokyo, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Katsunori Suzuki
- Division of Infection Control and Prevention, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Motoi Uchino
- Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | | | | | - Shinya Kusachi
- Department of Surgery, Tohokamagaya Hospital, Chiba, Japan
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11
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Chan KS, Chia CLK, Ng FKL, Seow WHJ, Leong DY, Shelat VG. Impaired Handgrip Strength Does Not Predict Postoperative Morbidity in Major Hepatobiliary Surgery. J Surg Res 2020; 256:549-556. [PMID: 32799004 DOI: 10.1016/j.jss.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 06/18/2020] [Accepted: 07/11/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Assessment of preoperative handgrip strength (HGS) is an objective and inexpensive bedside tool, which has been investigated to predict morbidity risk in elective surgery. However, its use is not validated in patients undergoing major elective hepatobiliary surgery (MEHS). The aim of this study is to investigate the use of HGS to predict morbidity in patients undergoing MEHS. METHODS This is a single-center prospective study involving 81 patients who underwent MEHS over 21 mo from July 2014 to March 2016. MEHS was defined as any hepatobiliary surgery expected to last more than 2 h and/or with an anticipated blood loss of ≥500 mL. HGS was assessed in both dominant and nondominant hands with standardization and subsequently recorded and expressed as a percentage of a general, age- and gender-matched normative values. RESULTS The mean age was 65.2 ± 9.5 y with male predominance (n = 52, 64.2%). Approximately, half of the patients underwent liver resection (n = 43, 53.1%). There was no difference in the incidence of Clavien-Dindo ≥ grade IIIA in both dominant HGS (impaired HGS 8/33 [24.2%], normal HGS 6/48 [12.5%]; P = 0.170) and nondominant HGS (impaired HGS 8/33 [21.1%], normal HGS 6/43 [14%]; P = 0.399). Dominant and nondominant HGS showed poor discriminatory ability in the prediction of Clavien-Dindo ≥ grade IIIA complications (dominant HGS area under the curve [AUC] = 0.572; nondominant HGS AUC 0.545). However, the use of dominant HGS showed moderate discriminatory ability to predict the length of hospital stay ≥21 d (AUC = 0.759). CONCLUSIONS The use of HGS may not predict Clavien-Dindo ≥ grade IIIA complications, but predicts a prolonged length of hospital stay ≥21 d.
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Affiliation(s)
- Kai Siang Chan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Felicia Kai Lin Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore.
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12
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Williams RW, Cole S, Holt DE. Microorganisms associated with incisional infections after gastrointestinal surgery in dogs and cats. Vet Surg 2020; 49:1301-1306. [PMID: 32779226 DOI: 10.1111/vsu.13495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/10/2020] [Accepted: 07/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the rate of incisional infections after gastrointestinal surgery in dogs and cats and describe the aerobic bacteria isolated from these infections. STUDY DESIGN Retrospective study. ANIMALS Client-owned dogs (n = 210) and cats (n = 66). METHODS Records of dogs and cats that underwent gastrointestinal surgery at the Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania were reviewed for surgical procedures, presence of an infection, bacterial species isolated, perioperative antimicrobials administered, and outcome. RESULTS The median duration of follow-up was 14 days (4-35). Incisional infections were recorded in 7% (20/276) of cases. Among those 20 cases, culture results were available in 12 of 20 cases. The most common bacterial isolate cultured was Escherichia coli. The most common perioperative antimicrobials administered to treat incisional infection were cefazolin and cefoxitin. Only two of the bacterial isolates were susceptible to these antimicrobials. Bacteria isolated from incisional infections were most often susceptible to chloramphenicol, imipenem, and gentamicin. CONCLUSION Bacterial isolates from incisional infections in this population consisted of native gastrointestinal flora, which was often resistant to the most commonly used perioperative antimicrobials. CLINICAL SIGNIFICANCE Contamination at time of surgery is the most likely source of incisional infection after gastrointestinal surgery. This rate of infection justifies more rigorous intraoperative hygiene protocols and evaluation of the antimicrobials' susceptibility of causative bacteria to guide antimicrobial treatment.
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Affiliation(s)
- Rachel W Williams
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen Cole
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E Holt
- Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Evaluation of negative-pressure wound therapy for surgical site infections after ileostomy closure in colorectal cancer patients: a prospective multicenter study. Surg Today 2020; 50:1687-1693. [PMID: 32638132 DOI: 10.1007/s00595-020-02068-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Surgical site infection (SSI) occurs at a high rate after ileostomy closure. The effect of preventive negative-pressure wound therapy (NPWT) on SSI development in closed wounds remains controversial. We conducted a prospective multicenter study to evaluate the usefulness of preventive NPWT for SSI after ileostomy closure. METHODS From January 2018 to November 2018, 50 patients who underwent closure of ileostomy created after surgery for colorectal cancer participated in this study. An NPWT device was applied to each wound immediately after surgery and then treatment was continued for 3 days. The primary endpoint was 30-day SSI, and the secondary endpoints were the incidence of seroma, hematoma, and adverse events related to NPWT. RESULTS No patients developed SSI, seroma, or hematoma. Adverse events that may have been causally linked with NPWT were contact dermatitis in two patients and wound pain in one patient, and there were no cases of discontinuation or decompression of NPWT. CONCLUSION The use of NPWT following ileostomy closure may be useful for reducing the development of SSI in colorectal cancer patients. This is a prospective multicenter pilot study and we are planning a comparative study based on these successful results. TRAIL REGISTRATION Registration number: UMIN000032053 ( https://www.umin.ac.jp/ ).
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14
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Thom H, Norman G, Welton NJ, Crosbie EJ, Blazeby J, Dumville JC. Intra-Cavity Lavage and Wound Irrigation for Prevention of Surgical Site Infection: Systematic Review and Network Meta-Analysis. Surg Infect (Larchmt) 2020; 22:144-167. [PMID: 32352895 DOI: 10.1089/sur.2019.318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Surgical site infections (SSIs) are costly and associated with poorer patient outcomes. Intra-operative surgical site irrigation and intra-cavity lavage may reduce the risk of SSIs through removal of dead or damaged tissue, metabolic waste, and site exudate. Irrigation with antibiotic or antiseptic solutions may further reduce the risk of SSI because of bacteriocidal properties. Randomized controlled trials (RCTs) have been conducted comparing irrigation solutions, but important comparisons (e.g., antibiotic vs. antiseptic irrigation) are absent. We use systematic review-based network meta-analysis (NMA) of RCTs to compare irrigation solutions for prevention of SSI. Methods: We used Cochrane methodology and included all RCTs of participants undergoing a surgical procedure with primary site closure, in which method of irrigation was the only systematic difference between groups. We used a random effects Bayesian NMA to create a connected network of comparisons. Results are presented as odds ratios (OR) of SSI, where OR <1 indicates a beneficial effect. Results: We identified 42 eligible RCTs with 11,726 participants. Most were at unclear or high risk of bias. The RCTs included groups given no irrigation or non-antibacterial, antiseptic, or antibiotic irrigation. There was substantial heterogeneity, and a random effects model was selected. Relative to non-antibacterial irrigation, mean OR of SSI was 0.439 (95% credible interval: 0.282, 0.667) for antibiotic irrigation and 0.573 (0.321, 0.953) for antiseptic agents. No irrigation was similar to non-antibacterial irrigation (OR 0.959 [0.555, 1.660]). Antibiotic and antiseptic irrigation were ranked as most effective for preventing SSIs; this conclusion was robust to potential bias. Conclusions: Our NMA found that antibiotic and antiseptic irrigation had the lowest odds of SSI. There was high heterogeneity, however, and studies were at high risk of bias. A large RCT directly comparing antibiotic irrigation with both antiseptic and non-antibacterial irrigation is needed to define the standard of care for SSI prevention by site irrigation.
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Affiliation(s)
- Howard Thom
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester University NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Nicky J Welton
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emma J Crosbie
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, Manchester University NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Jane Blazeby
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Manchester University NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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15
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De Simone B, Sartelli M, Coccolini F, Ball CG, Brambillasca P, Chiarugi M, Campanile FC, Nita G, Corbella D, Leppaniemi A, Boschini E, Moore EE, Biffl W, Peitzmann A, Kluger Y, Sugrue M, Fraga G, Di Saverio S, Weber D, Sakakushev B, Chiara O, Abu-Zidan FM, ten Broek R, Kirkpatrick AW, Wani I, Coimbra R, Baiocchi GL, Kelly MD, Ansaloni L, Catena F. Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 2020; 15:10. [PMID: 32041636 PMCID: PMC7158095 DOI: 10.1186/s13017-020-0288-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/01/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. METHODS The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. RESULTS Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. CONCLUSIONS The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.
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Affiliation(s)
- Belinda De Simone
- Department of General Surgery, Azienda USL-IRCSS di Reggio Emilia, Guastalla Hospital, Via Donatori di sangue 1, 42016 Guastalla, RE Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, 62100 Macerata, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, 56124 Pisa, Italy
| | - Chad G. Ball
- Department of Surgery and Oncology, Hepatobiliary and Pancreatic Surgery, Trauma and Acute Care Surgery, University of Calgary Foothills Medical Center, Calgary, Alberta T2N 2T9 Canada
| | - Pietro Brambillasca
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Massimo Chiarugi
- Emergency Surgery Unit and Trauma Center, Cisanello Hospital, Pisa, Italy
| | | | - Gabriela Nita
- Unit of General Surgery, Castelnuovo ne’Monti Hospital, AUSL, Reggio Emilia, Italy
| | - Davide Corbella
- Anesthesia and Critical Care Department, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ari Leppaniemi
- Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland
| | - Elena Boschini
- Medical Library, Papa Giovanni XXIII Hospital, P.zza OMS 1, 24128 Bergamo, Italy
| | - Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health and University of Colorado, Denver, USA
| | - Walter Biffl
- Trauma and Acute Care Surgery, Scripps memorial Hospital, La Jolla, CA USA
| | - Andrew Peitzmann
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Letterkenny, Ireland
| | - Gustavo Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, SP Brazil
| | | | - Dieter Weber
- Trauma and General Surgery, Royal Perth Hospital, Perth, Australia
| | - Boris Sakakushev
- University Hospital St George First, Clinic of General Surgery, Plovdiv, Bulgaria
| | - Osvaldo Chiara
- State University of Milan, Acute Care Surgery Niguarda Hospital, Milan, Italy
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | | | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Raul Coimbra
- Department of Surgery, UC San Diego Medical Center, San Diego, USA
| | | | - Micheal D. Kelly
- Department of General Surgery, Albury Hospital, Albury, NSW 2640 Australia
| | - Luca Ansaloni
- Department of Emergency and Trauma Surgery, Bufalini Hospital, 47521 Cesena, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, University Hospital of Parma, 43100 Parma, Italy
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Tomita K, Chiba N, Ochiai S, Yokozuka K, Gunji T, Hikita K, Ozawa Y, Okihara M, Sano T, Tsutsui R, Shimazu M, Kawachi S. Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples. J Gastrointest Surg 2018; 22:1385-1393. [PMID: 29633116 DOI: 10.1007/s11605-018-3754-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/20/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE Postoperative superficial surgical site infection is a major complication in hepatobiliary-pancreatic surgery. We aimed to compare the efficacy of subcuticular sutures versus staples for skin closure in preventing superficial surgical site infection in hepatobiliary-pancreatic surgery. METHODS Consecutive patients who underwent hepatobiliary-pancreatic surgery at our hospital from October 2006 to March 2011 and from April 2012 to March 2015 were reviewed retrospectively. Superficial surgical site infection incidence was evaluated in patients who received subcuticular sutures and those who received staples for skin closure. Propensity score matching analysis was used to adjust bias from confounding factors. RESULTS A total of 691 patients were included. Patients with skin staple closures (n = 346) were compared with patients with subcuticular suture closures (n = 345). After a propensity score matching analysis, a significant difference in superficial surgical site infection incidence was found between the skin stapler group (11.3%) and subcuticular sutures group (2.6%). The same comparison was performed by a subgroup analysis and supported this finding in patients after hepatectomy without biliary reconstruction, pancreatoduodenectomy, or open laparotomy surgeries and in patients with body mass index < 25. CONCLUSIONS Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.
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Affiliation(s)
- Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan.
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeto Ochiai
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kei Yokozuka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Kosuke Hikita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Yosuke Ozawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Masaaki Okihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Rina Tsutsui
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Motohide Shimazu
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo, 193-0998, Japan
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17
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Itatsu K, Yokoyama Y, Sugawara G, Kamiya S, Terasaki M, Morioka A, Iyomasa S, Shirai K, Ando M, Nagino M. The Benefits of a Wound Protector in Preventing Incisional Surgical Site Infection in Elective Open Digestive Surgery: A Large-Scale Cohort Study. World J Surg 2018; 41:2715-2722. [PMID: 28608019 DOI: 10.1007/s00268-017-4082-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the benefits of wound protectors (WPs) in preventing incisional surgical site infection (I-SSI) in open elective digestive surgery using data from a large-scale, multi-institutional cohort study. METHODS Patients who had elective digestive surgery for malignant neoplasms between November 2009 and February 2011 were included. The protective value of WPs against I-SSI was evaluated. RESULTS A total of 3201 patients were analyzed. A WP was used in 1022 patients (32%). The incident rate of I-SSI (not including organ/space SSI) was 9%. In the univariate and the multivariate analyses for perioperative risk factors for I-SSI, the use of WP was an independent favorable factor that reduced the incidence of I-SSI (odds ratio 0.73, 95% confidence interval 0.55-0.98. P = 0.038). The subgroup forest plot analyses revealed that WP reduced the risk of I-SSI only in patients aged 74 years or younger, males, non-obese patients (body mass index <25 kg/m2), patients with an American Society of Anesthesiologists score of 1/2, patients with a previous history of laparotomy, non-smokers, and patients who underwent colon and rectum operations. In patients who underwent colorectal surgery, the postoperative hospital stay was significantly shorter in patients with WP than those without WP (median 13 vs. 15 days, P = 0.040). In terms of the depth of SSI, WP only prevented superficial I-SSI and did not reduce the incidence of deep I-SSI. CONCLUSIONS WP is a useful device for preventing superficial I-SSI in open elective digestive surgery. TRIAL REGISTRATION NUMBER UMIN000004723.
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Affiliation(s)
- Keita Itatsu
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.,Department of Surgery, Kamiiida Daiichi General Hospital, Nagoya, Japan
| | - Yukihiro Yokoyama
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Gen Sugawara
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Satoaki Kamiya
- Department of Surgery, Tsushima Municipal Hospital, Tsushima, Japan
| | - Masaki Terasaki
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Atsushi Morioka
- Department of Surgery, Kumiai Kosei Hospital, Takayama, Japan
| | | | - Kazuhisa Shirai
- Department of Surgery, Yamashita Hospital, Ichinomiya, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Masato Nagino
- The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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Norman G, Atkinson RA, Smith TA, Rowlands C, Rithalia AD, Crosbie EJ, Dumville JC. Intracavity lavage and wound irrigation for prevention of surgical site infection. Cochrane Database Syst Rev 2017; 10:CD012234. [PMID: 29083473 PMCID: PMC5686649 DOI: 10.1002/14651858.cd012234.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery. OBJECTIVES To assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI). SEARCH METHODS In February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting. SELECTION CRITERIA We included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where possible. MAIN RESULTS We included 59 RCTs with 14,738 participants. Studies assessed comparisons between irrigation and no irrigation, between antibacterial and non-antibacterial irrigation, between different antibiotics, different antiseptics or different non-antibacterial agents, or between different methods of irrigation delivery. No studies compared antiseptic with antibiotic irrigation. Surgical site infectionIrrigation compared with no irrigation (20 studies; 7192 participants): there is no clear difference in risk of SSI between irrigation and no irrigation (RR 0.87, 95% CI 0.68 to 1.11; I2 = 28%; 14 studies, 6106 participants). This would represent an absolute difference of 13 fewer SSIs per 1000 people treated with irrigation compared with no irrigation; the 95% CI spanned from 31 fewer to 10 more SSIs. This was low-certainty evidence downgraded for risk of bias and imprecision.Antibacterial irrigation compared with non-antibacterial irrigation (36 studies, 6163 participants): there may be a lower incidence of SSI in participants treated with antibacterial irrigation compared with non-antibacterial irrigation (RR 0.57, 95% CI 0.44 to 0.75; I2 = 53%; 30 studies, 5141 participants). This would represent an absolute difference of 60 fewer SSIs per 1000 people treated with antibacterial irrigation than with non-antibacterial (95% CI 35 fewer to 78 fewer). This was low-certainty evidence downgraded for risk of bias and suspected publication bias.Comparison of irrigation of two agents of the same class (10 studies; 2118 participants): there may be a higher incidence of SSI in participants treated with povidone iodine compared with superoxidised water (Dermacyn) (RR 2.80, 95% CI 1.05 to 7.47; low-certainty evidence from one study, 190 participants). This would represent an absolute difference of 95 more SSIs per 1000 people treated with povidone iodine than with superoxidised water (95% CI 3 more to 341 more). All other comparisons found low- or very low-certainty evidence of no clear difference between groups.Comparison of two irrigation techniques: two studies compared standard (non-pulsed) methods with pulsatile methods. There may, on average, be fewer SSIs in participants treated with pulsatile methods compared with standard methods (RR 0.34, 95% CI 0.19 to 0.62; I2 = 0%; two studies, 484 participants). This would represent an absolute difference of 109 fewer SSIs occurring per 1000 with pulsatile irrigation compared with standard (95% CI 62 fewer to 134 fewer). This was low-certainty evidence downgraded twice for risks of bias across multiple domains. Wound dehiscenceFew studies reported wound dehiscence. No comparison had evidence for a difference between intervention groups. This included comparisons between irrigation and no irrigation (one study, low-certainty evidence); antibacterial and non-antibacterial irrigation (three studies, very low-certainty evidence) and pulsatile and standard irrigation (one study, low-certainty evidence). Secondary outcomesFew studies reported outcomes such as use of systemic antibiotics and antibiotic resistance and they were poorly and incompletely reported. There was limited reporting of mortality; this may have been partially due to failure to specify zero events in participants at low risk of death. Adverse event reporting was variable and often limited to individual event types. The evidence for the impact of interventions on length of hospital stay was low or moderate certainty; where differences were seen they were too small to be clinically important. AUTHORS' CONCLUSIONS The evidence base for intracavity lavage and wound irrigation is generally of low certainty. Therefore where we identified a possible difference in the incidence of SSI (in comparisons of antibacterial and non-antibacterial interventions, and pulsatile versus standard methods) these should be considered in the context of uncertainty, particularly given the possibility of publication bias for the comparison of antibacterial and non-antibacterial interventions. Clinicians should also consider whether the evidence is relevant to the surgical populations under consideration, the varying reporting of other prophylactic antibiotics, and concerns about antibiotic resistance.We did not identify any trials that compared an antibiotic with an antiseptic. This gap in the direct evidence base may merit further investigation, potentially using network meta-analysis; to inform the direction of new primary research. Any new trial should be adequately powered to detect a difference in SSIs in eligible participants, should use robust research methodology to reduce the risks of bias and internationally recognised criteria for diagnosis of SSI, and should have adequate duration and follow-up.
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Affiliation(s)
- Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Ross A Atkinson
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Tanya A Smith
- Southmead Hospital, North Bristol Foundation TrustTrauma and OrthopaedicsSouthmead WayBristolAvonUKBS10 5NB
| | - Ceri Rowlands
- Severn Deanery, Health Education South West, EnglandGeneral SurgeryFlat 407, 51.02 ApartmentsBristolUKBS1 3LY
| | - Amber D Rithalia
- Independent Researcher7 Victoria Terrace, KirkstallLeedsUKLS5 3HX
| | - Emma J Crosbie
- Faculty of Biology, Medicine and Health, University of ManchesterDivision of Cancer Sciences5th Floor ‐ ResearchSt Mary's HospitalManchesterUKM13 9WL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
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19
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Fry DE. Pressure Irrigation of Surgical Incisions and Traumatic Wounds. Surg Infect (Larchmt) 2017; 18:424-430. [DOI: 10.1089/sur.2016.252] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Donald E. Fry
- MPA Healthcare Solutions, Chicago, Illinois; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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de Jonge SW, Boldingh QJJ, Solomkin JS, Allegranzi B, Egger M, Dellinger EP, Boermeester MA. Systematic Review and Meta-Analysis of Randomized Controlled Trials Evaluating Prophylactic Intra-Operative Wound Irrigation for the Prevention of Surgical Site Infections. Surg Infect (Larchmt) 2017; 18:508-519. [PMID: 28448203 DOI: 10.1089/sur.2016.272] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Surgical site infections (SSIs) are one of the most common hospital-acquired infections. To reduce SSIs, prophylactic intra-operative wound irrigation (pIOWI) has been advocated, although the results to date are equivocal. To develop recommendations for the new World Health Organization (WHO) SSI prevention guidelines, a systematic literature review and a meta-analysis were conducted on the effectiveness of pIOWI using different agents as a means of reducing SSI. METHODS The PUBMED, Embase, CENTRAL, CINAHL, and WHO databases were searched. Randomized controlled trials (RCTs) comparing either pIOWI with no pIOWI or with pIOWI using different solutions and techniques were retrieved with SSI as the primary outcome. Meta-analyses were performed, and odds ratios (OR) and the mean difference with 95% confidence intervals (CI) were extracted and pooled with a random effects model. RESULTS Twenty-one studies were suitable for analysis, and a distinction was made between intra-peritoneal, mediastinal, and incisional wound irrigation. A low quality of evidence demonstrated a statistically significant benefit for incisional wound irrigation with an aqueous povidone-iodine (PVP-I) solution in clean and clean contaminated wounds (OR 0.31; 95% CI 0.13-0.73; p = 0.007); 50 fewer SSIs per 1,000 procedures (from 19 fewer to 64 fewer)). Antibiotic irrigation had no significant effect in reducing SSIs (OR 1.16; 95% CI 0.64-2.12; p = 0.63). CONCLUSION Low-quality evidence suggests considering the use of prophylactic incisional wound irrigation to prevent SSI with an aqueous povidone-iodine solution. Antibiotic irrigation does not show a benefit and therefore is discouraged.
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Affiliation(s)
- Stijn W de Jonge
- 1 Department of Surgery, Academic Medical Center Amsterdam , The Netherlands
| | | | - Joseph S Solomkin
- 2 Department of Surgery, University of Cincinnati College of Medicine , Cincinnati, Ohio
| | - Benedetta Allegranzi
- 3 Infection Prevention and Control Global Unit, Service Delivery and Safety, World Health Organization , Geneva, Switzerland
| | - Matthias Egger
- 4 Institute of Social and Preventive Medicine, University of Bern , Bern, Switzerland
| | | | - Marja A Boermeester
- 1 Department of Surgery, Academic Medical Center Amsterdam , The Netherlands
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Mori H, Rahman A, Kobara H, Fujihara S, Nishiyama N, Ayaki M, Matsunaga T, Murakami M, Masaki T. Current Status of Exposed Endoscopic Full-Thickness Resection and Further Development of Non-Exposed Endoscopic Full-Thickness Resection. Digestion 2017; 95:6-15. [PMID: 28052273 DOI: 10.1159/000452352] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic full-thickness resection (EFTR) is a procedure that makes it possible to access the lesions that are on the wall of the digestive tract via the shortest distance through the mouth. Because of the ultra-minimal invasive nature of the treatment, pure EFTR is a highly promising surgical procedure that allows the radical excision of full-thickness layers of digestive tract tumors using only a flexible endoscope. There are 2 types of EFTR methods: exposed and non-exposed. Considering the risks of contracting infection and intraperitoneal dissemination of tumor cells, non-exposed EFTR is an ideal method. However, a number of issues remain unresolved, including the method for performing a full-thickness suture under endoscopic view and the challenge of securing the operating field in the case of gastrointestinal tract collapse. Moreover, advances in the development of equipment such as full-thickness suturing devices would be helpful to make this therapeutic procedure the most minimally invasive endoscopic surgery ever.
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Affiliation(s)
- Hirohito Mori
- Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Takamatsu, Japan
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22
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Park HM, Han SS, Lee EC, Lee SD, Yoon HM, Eom BW, Kim SH, Ryu KW, Park SJ, Kim YW, Park B. Randomized clinical trial of preoperative skin antisepsis with chlorhexidine gluconate or povidone–iodine. Br J Surg 2016; 104:e145-e150. [DOI: 10.1002/bjs.10395] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/04/2016] [Accepted: 09/06/2016] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Skin antiseptic agents are used to prevent surgical-site infection (SSI); few trials have reported the superiority of any specific agent in clean-contaminated abdominal surgery. This RCT was designed to compare the effectiveness of chlorhexidine gluconate and povidone–iodine.
Methods
Consecutive patients who underwent clean-contaminated upper gastrointestinal or hepatobiliary–pancreatic open surgery between 2011 and 2014 were assigned randomly to either chlorhexidine gluconate or povidone–iodine. The primary endpoint was the occurrence of SSI within 30 days of surgery. Secondary endpoints included causative organisms and risk factors for SSI.
Results
A total of 534 patients were randomized; 31 (5·8 per cent) developed an SSI. There was no difference in the overall SSI rate in the chlorhexidine gluconate and povidone–iodine groups: 15 of 267 (5·6 per cent) and 16 of 267 (6·0 per cent) respectively (P = 0·853). The most common causative organism was Enterococcus faecalis. In subgroup analysis, biliary–pancreatic surgery had a higher SSI rate (26 of 127, 20·5 per cent) than upper gastrointestinal (2 of 204, 1·0 per cent) and hepatic (3 of 203, 1·5 per cent) resection. Both age (60 years and over) and type of incision were associated with the risk of SSI.
Conclusion
No difference was detected between chlorhexidine gluconate and povidone–iodine antiseptics for prevention of SSI. Registration number: NCT01495117 (http://www.clinicaltrials.gov).
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Affiliation(s)
- H M Park
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - S-S Han
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - E C Lee
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - S D Lee
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - H M Yoon
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - B W Eom
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - S H Kim
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - K W Ryu
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - S-J Park
- Centre for Liver Cancer, National Cancer Centre, South Korea
| | - Y W Kim
- Centre for Gastric Cancer, National Cancer Centre, South Korea
| | - B Park
- Biometric Research Branch, Research Institute and Hospital, National Cancer Centre, South Korea
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23
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Majumder A, Miller HJ, Patel P, Wu YV, Elliott HL, Novitsky YW. Evaluation of antibiotic pressurized pulse lavage for contaminated retromuscular abdominal wall reconstruction. Surg Endosc 2016; 31:2763-2770. [PMID: 27800587 DOI: 10.1007/s00464-016-5283-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite patient risk factors such as diabetes and obesity, contamination during surgery remains a significant cause of infections and subsequent wound morbidity. Pressurized pulse lavage (PPL) has been utilized as a method to reduce bacterial bioburden with promising results in many fields. Although existing methods of lavage have been utilized during abdominal operations, no studies have examined the use of PPL during complex hernia repair. METHODS Patients undergoing abdominal wall reconstruction (AWR) in clean-contaminated or contaminated fields with antibiotic PPL, from January 2012 to May 2013, were prospectively evaluated. Primary outcome measures studied were conversion of retrorectus space culture from positive to negative after PPL and 30-day surgical site infection (SSI) rate. RESULTS A total of 56 patients underwent AWR, with 44 patients (78.6 %) having clean-contaminated fields and 12 patients (21.4 %) having contaminated ones. Twenty-two patients (39.3 %) had positive pre-PPL cultures, 18 of which (81.8 %) converted to negative cultures after PPL. Eleven patients (19.6 %) developed SSIs. Those with persistently positive cultures after PPL had the highest rate of SSI, where two out of four patients (50.0 %) developed an SSI. Contrastingly, only 5 of 18 patients (27.8 %) who converted from a positive to negative culture after PPL developed an SSI. CONCLUSION Our findings demonstrate that antibiotic PPL is an effective method to reduce bacterial bioburden during AWR in clean-contaminated and contaminated fields. While complete conversion and eradication of SSI were not achieved, we believe that PPL may be a useful adjunct to standard operative asepsis in preventing prosthetic contamination during contaminated AWR.
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Affiliation(s)
- Arnab Majumder
- Department of Surgery, UH Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Heidi J Miller
- Department of Surgery, UH Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Parita Patel
- Department of Surgery, UH Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Yuhsin V Wu
- Department of Surgery, UH Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Heidi L Elliott
- Department of Surgery, UH Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Yuri W Novitsky
- Department of Surgery, UH Comprehensive Hernia Center, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM, Gans S, Wallert ED, Wu X, Abbas M, Boermeester MA, Dellinger EP, Egger M, Gastmeier P, Guirao X, Ren J, Pittet D, Solomkin JS. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. THE LANCET. INFECTIOUS DISEASES 2016; 16:e288-e303. [PMID: 27816414 DOI: 10.1016/s1473-3099(16)30402-9] [Citation(s) in RCA: 532] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/28/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
Surgical site infections (SSIs) are the most common health-care-associated infections in developing countries, but they also represent a substantial epidemiological burden in high-income countries. The prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations in national guidelines have been identified. Considering the prevention of SSIs as a priority for patient safety, WHO has developed evidence-based and expert consensus-based recommendations on the basis of an extensive list of preventive measures. We present in this Review 16 recommendations specific to the intraoperative and postoperative periods. The WHO recommendations were developed with a global perspective and they take into account the balance between benefits and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.
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Affiliation(s)
- Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland.
| | - Bassim Zayed
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Peter Bischoff
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - N Zeynep Kubilay
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Stijn de Jonge
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Fleur de Vries
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Sarah Gans
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Elon D Wallert
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Xiuwen Wu
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Mohamed Abbas
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marja A Boermeester
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | | | - Jianan Ren
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Joseph S Solomkin
- OASIS Global, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Pochhammer J, Weller MP, Schäffer M. Polihexanide for prevention of Wound Infection in Surgery. Is the contact time essential? POLIS-trial: A historic controlled, clinical pilot trial. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.wndm.2016.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Infection control in colon surgery. Langenbecks Arch Surg 2016; 401:581-97. [DOI: 10.1007/s00423-016-1467-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 01/27/2023]
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Mori H, Kobara H, Nishiyama N, Fujihara S, Masaki T. Review of Pure Endoscopic Full-Thickness Resection of the Upper Gastrointestinal Tract. Gut Liver 2016; 9:590-600. [PMID: 26343069 PMCID: PMC4562775 DOI: 10.5009/gnl14380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue.
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Affiliation(s)
- Hirohito Mori
- Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Hideki Kobara
- Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Noriko Nishiyama
- Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Shintaro Fujihara
- Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan
| | - Tsutomu Masaki
- Department of Gastroenterology and Neurology, Kagawa University, Kita, Japan
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McDermott FD, Folan DMA, Winter DC, Folan MA, Baird AW. Gnotobiotic Human Colon Ex Vivo. Gastroenterology Res 2015; 8:247-252. [PMID: 27785304 PMCID: PMC5051042 DOI: 10.14740/gr675w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 01/17/2023] Open
Abstract
Background A novel emulsion with efficacy as an agent for eliminating biofilms was selected. The aim of this study was to examine efficacy and effect of a formulation of ML:8 against commensal bacteria harvested from ex vivo human colonic tissues. Methods Mucosal sheets, obtained at the time of surgery, were exposed for 2 minutes to one of four solutions: Krebs-Hensleit (KH) solution, saline (NaCl; 0.9%), povidone iodine (1%), or ML:8 (2%); n = 4. Lumenal surfaces were swabbed for culture under aerobic or anaerobic conditions. Following treatment, each sheet was mounted in Ussing chambers and voltage clamped. Tissues were challenged with carbachol. Permeability coefficient (Papp) was determined using mannitol fluxes. At the end of each experiment, tissues were examined histologically. Results Similar colony forming units grew in aerobic and anaerobic conditions in both control and NaCl treated tissues. Iodine reduced and ML:8 virtually abolished viable bacteria. Basal electrophysiological parameters were not different between treatments. Transepithelial electrical resistance values did not differ between groups. All tissues responded to carbachol, although this was attenuated in iodine treated tissue. Papp values were slightly elevated in all treated tissues but this did not reach significance. Histopathological assessment revealed no overt damage to tissues. Conclusion Brief exposure to ML:8 reduced culturable bacterial burden from human intestinal tissues harvested at the time of surgical resection. Such gnotobiotic tissues retain structural and functional integrity. This is a novel approach to reduce bacterial burden.
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Affiliation(s)
- Frank D McDermott
- UCD School of Veterinary Medicine & Conway Institute of Biomolecular & Biomedical Science, University College Dublin, Belfield, Dublin 4, Ireland; UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; These authors contributed equally to the study
| | - David M A Folan
- UCD School of Veterinary Medicine & Conway Institute of Biomolecular & Biomedical Science, University College Dublin, Belfield, Dublin 4, Ireland; These authors contributed equally to the study
| | - Des C Winter
- UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michael A Folan
- UCD School of Veterinary Medicine & Conway Institute of Biomolecular & Biomedical Science, University College Dublin, Belfield, Dublin 4, Ireland
| | - Alan W Baird
- UCD School of Veterinary Medicine & Conway Institute of Biomolecular & Biomedical Science, University College Dublin, Belfield, Dublin 4, Ireland
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Scientific surgery. Br J Surg 2014. [DOI: 10.1002/bjs.9741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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