USA Department of Defense audit of surgical antibiotic prophylaxis prescribing patterns in inguinal hernia repair

Traditionally, the operation of hernia is considered as a clean operation due to expected, low incidence of infection, on the spot of surgical work (SSI). The incidence of SSI in hernia surgery is more frequent then it is assumed. The important risk factors for SSI are the following: type of hernia (inguinal, incisional), operative approach (open - laparoscopic), usage of the prosthetic material and drainage. Comparing to inguinal hernia repair, incisional hernia repair, is more frequently followed by the infection. The laparoscopic operations are followed with the lower incidence of SSI then in the case of open operation. The usage of the mesh does not increase the incidence of SSI, although the consequences of the mesh infection may be severe. A type I of the prosthesis is more resistant to the infection then prosthesis II and III. The mesh infection (type I) never involves its body but it is present around sutures and bended edges. The mesh infection Type II involves entire prosthesis while in the case of Type III it is present in its peripheral part. In the case of SSI, a prosthesis Type I is possible to be saved, while prosthesis Type II must be removed completely; and the same is for the Type III (the partial removal is rarely suggested). The defect that remained after excision of non-resorptive prosthesis is a long-term and very complicated surgical problem. In regard to the position of the mesh, SSI is more common if the mesh is placed subcutaneously then in the case of sub-aponeurotic peri-muscular, pre-aponeurotic retromuscular or pre-peritoneal mesh placemen. If the infection is present the non-tension techniques using non-resorptive prosthetic implants are not recommended. the presence of drainage and its duration increases the incidence of SSI. It is more common for incisional hernioplasty then for inguinal hernia repair. If there is an indication for drainage it should be as short as possible. The cause of SSI for elective operations are bacteria?s that arrives from the skin, while in the case of opening of various organs dominant bacteria?s originate from them. The superficial infection does not lead to the recurrence, while it is very possible in the case for deep infection. There are no prospective studies that justify the usage of antibiotic prophylaxes in hernia surgery. The antibiotic prophylaxis in hernia surgery. The antibiotic prophylaxis is indicated for the clean operations when placing the implants and when severe complication is expected. The appearance of SSI increases the price of treatment and may lead to the recurrence.

Download Full-text

Adherence to antibiotic prophylaxis trust guidelines for elective inguinal hernia repair and laparoscopic cholecystectomy: A re-Audit.

International Journal of Surgery ◽

10.1016/j.ijsu.2014.07.233 ◽

2014 ◽

Vol 12 ◽

pp. S51

Author(s):

Kathryn O'Shea ◽

Caroline Cozon ◽

Magdi Hanafy

Keyword(s):

Laparoscopic Cholecystectomy ◽

Inguinal Hernia ◽

Hernia Repair ◽

Antibiotic Prophylaxis ◽

Inguinal Hernia Repair

Download Full-text

The cost of inappropriate antibiotic prophylaxis in inguinal hernia repair surgery

International Journal of Surgery ◽

10.1016/j.ijsu.2015.07.320 ◽

2015 ◽

Vol 23 ◽

pp. S72-S73

Author(s):

F. Ross ◽

N. Jones ◽

A. Townend ◽

P. Bhaskar

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Antibiotic Prophylaxis ◽

Inguinal Hernia Repair ◽

The Cost

Download Full-text

Opioid use after outpatient elective general surgery: quantifying the burden of persistent use

British Journal of Pain ◽

10.1177/20494637211032907 ◽

2021 ◽

pp. 204946372110329

Author(s):

Collin Clarke ◽

Andrew McClure ◽

Laura Allen ◽

Luke Hartford ◽

Julie Ann Van Koughnett ◽

...

Keyword(s):

Risk Factors ◽

Laparoscopic Cholecystectomy ◽

Inguinal Hernia ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Prescribing Patterns ◽

Income Quintile ◽

Opioid Use ◽

Opioid Prescription ◽

Open Inguinal Hernia Repair

Purpose: Surgery is a major risk factor for chronic opioid use among patients who had not recently been prescribed opioids. This study identifies the rate of, and risk factors for, persistent opioid use following laparoscopic cholecystectomy and open inguinal hernia repair in patients not recently prescribed opioids. Methods: This retrospective population-based cohort study included all patients who had not been prescribed opioids in the 6 months prior to undergoing open inguinal hernia repair or laparoscopic cholecystectomy from January 2013 to July 2016 in Ontario. Opioid prescription was identified from the provincial Narcotics Monitoring System and data were obtained from the Institute for Clinical Evaluative Sciences. The primary outcome was persistent opioid use after surgery (3, 6, 9 and 12 months). Associated risk factors and prescribing patterns were also examined. Results: Among the 90,326 patients in the study cohort, 80% filled an opioid prescription after surgery, with 11%, 9%, 5% and 1% filling a prescription at 3, 6, 9 and 12 months, respectively. Significant variability was identified in the type of opioid prescribed (41% codeine, 31% oxycodone, 18% tramadol) and in regional prescribing patterns (mean prescription/region range, 135–225 oral morphine equivalents). Predictors of continued opioid use included age, female gender, lower income quintile and being operated on by less experienced surgeons. Conclusion: Most patients who undergo elective cholecystectomy and hernia repair will fill a prescription for an opioid after surgery, and many will continue to fill opioid prescriptions for considerably longer than clinically anticipated. There is important variability in opioid type, regional prescribing patterns and risk factors that identify strategic targets to reduce the opioid burden in this patient population.

Download Full-text