Benefits and Risks of Dexamethasone in Noncardiac Surgery

2021 ◽  
Author(s):  
Paul S. Myles ◽  
Tomas Corcoran
Keyword(s):  
Surgical Site Infection ◽  
Noncardiac Surgery ◽  
Large Trial ◽  
Site Infection ◽  
Quality Of Recovery ◽  
Meta Analyses ◽  
Increase In Risk

Dexamethasone is an effective antiemetic and improves patient quality of recovery. Meta-analyses and a recent large trial found no increase in risk of surgical site infection. Dexamethasone should be more widely used in perioperative practice.

scholarly journals Identification of post-cesarean surgical site infection: nursing consultation

2018 ◽  
Vol 71 (suppl 3) ◽  
pp. 1395-1403
Author(s):  
Marcia Regina Cunha ◽  
Maria Clara Padoveze ◽  
Célia Regina Maganha e Melo ◽  
Lucia Yasuko Izumi Nichiata
Keyword(s):  
Quality Of Service ◽  
Health Status ◽  
Surgical Site Infection ◽  
Medical Records ◽  
Signs And Symptoms ◽  
Site Infection ◽  
Cross Sectional ◽  
Cesarean Deliveries ◽  
The City

ABSTRACT Objective: To describe the profile of women in relation to their living conditions, health status and socio-demographic profile, correlating it with the presence of signs and symptoms suggestive of post-cesarean surgical site infection, identifying information to be considered in the puerperium consultation performed by nurses and proposing a roadmap for the systematization of care. Method: Quantitative, exploratory, descriptive, cross-sectional and retrospective review of medical records of women who had cesarean deliveries in 2014, in the city of São Paulo. Results: 89 medical records were analyzed, 62 of them with incomplete information. In 11, there was at least one of the signs and symptoms suggestive of infection. Conclusion: Given the results of the study, the systematization of puerperal consultation is essential. The roadmap is an instrument that can potentially improve the quality of service and the recording of information.

scholarly journals Negative-pressure wound therapy compared with standard dressings following surgical treatment of major trauma to the lower limb: the WHiST RCT

2020 ◽  
Vol 24 (38) ◽  
pp. 1-86
Author(s):  
Matthew L Costa ◽  
Juul Achten ◽  
Ruth Knight ◽  
May Ee Png ◽  
Julie Bruce ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Surgical Site Infection ◽  
Negative Pressure ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Major Trauma ◽  
Site Infection ◽  
Wound Therapy ◽  
Deep Surgical Site Infection

Background Major trauma is the leading cause of death in people aged < 45 years. Patients with major trauma usually have lower-limb fractures. Surgery to fix the fractures is complicated and the risk of infection may be as high as 27%. The type of dressing applied after surgery could potentially reduce the risk of infection. Objectives To assess the deep surgical site infection rate, disability, quality of life, patient assessment of the surgical scar and resource use in patients with surgical incisions associated with fractures following major trauma to the lower limbs treated with incisional negative-pressure wound therapy versus standard dressings. Design A pragmatic, multicentre, randomised controlled trial. Setting Twenty-four specialist trauma hospitals representing the UK Major Trauma Network. Participants A total of 1548 adult patients were randomised from September 2016 to April 2018. Exclusion criteria included presentation > 72 hours after injury and inability to complete questionnaires. Interventions Incisional negative-pressure wound therapy (n = 785), in which a non-adherent absorbent dressing covered with a semipermeable membrane is connected to a pump to create a partial vacuum over the wound, versus standard dressings not involving negative pressure (n = 763). Trial participants and the treating surgeon could not be blinded to treatment allocation. Main outcome measures Deep surgical site infection at 30 days was the primary outcome measure. Secondary outcomes were deep infection at 90 days, the results of the Disability Rating Index, health-related quality of life, the results of the Patient and Observer Scar Assessment Scale and resource use collected at 3 and 6 months post surgery. Results A total of 98% of participants provided primary outcome data. There was no evidence of a difference in the rate of deep surgical site infection at 30 days. The infection rate was 6.7% (50/749) in the standard dressing group and 5.8% (45/770) in the incisional negative-pressure wound therapy group (intention-to-treat odds ratio 0.87; 95% confidence interval 0.57 to 1.33; p = 0.52). There was no difference in the deep surgical site infection rate at 90 days: 13.2% in the standard dressing group and 11.4% in the incisional negative-pressure wound therapy group (odds ratio 0.84, 95% confidence interval 0.59 to 1.19; p = 0.32). There was no difference between the two groups in disability, quality of life or scar appearance at 3 or 6 months. Incisional negative-pressure wound therapy did not reduce the cost of treatment and was associated with a low probability of cost-effectiveness. Limitations Owing to the emergency nature of the surgery, we anticipated that some patients who were randomised would subsequently be unable or unwilling to participate. However, the majority of the patients (85%) agreed to participate. Therefore, participants were representative of the population with lower-limb fractures associated with major trauma. Conclusions The findings of this study do not support the use of negative-pressure wound therapy in patients having surgery for major trauma to the lower limbs. Future work Our work suggests that the use of incisional negative-pressure wound therapy dressings in other at-risk surgical wounds requires further investigation. Future research may also investigate different approaches to reduce postoperative infections, for example the use of topical antibiotic preparations in surgical wounds and the role of orthopaedic implants with antimicrobial coatings when fixing the associated fracture. Trial registration Current Controlled Trials ISRCTN12702354 and UK Clinical Research Network Portfolio ID20416. Funding This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 38. See the NIHR Journals Library for further project information.

scholarly journals A systematic review and meta-analysis of randomized controlled trials for the reduction of surgical site infection in closed incision management versus standard of care dressings over closed vascular groin incisions

Vascular ◽  
2020 ◽  
Vol 28 (3) ◽  
pp. 274-284 ◽  
Author(s):  
Alexander Gombert ◽  
Ellen Dillavou ◽  
Ralph D’Agostino ◽  
Leah Griffin ◽  
Julie M Robertson ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Surgical Site Infection ◽  
Meta Analysis ◽  
Site Infection ◽  
Infection Rates ◽  
Control Groups ◽  
Randomized Controlled ◽  
Risk Patients ◽  
Meta Analyses ◽  
And Control

Objective Surgical site infection after groin incision is a common complication and a financial burden to patients and healthcare systems. Closed incision negative pressure therapy (ciNPT) has been associated with decreased surgical site infection rates in published literature. This meta-analysis examines the effect of ciNPT (PREVENA™ Incision Management System; KCI, San Antonio, TX) versus traditional postsurgical dressing use in reducing surgical site infection rates over closed groin incisions following vascular surgery. Methods A systematic literature search using PubMed, OVID, EMBASE, and QUOSA was performed on 3 January 2019, by two independent researchers and focused on publications between 1 January 2005 and 31 December 2018. The review conformed to the statement and reporting check list of the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Inclusion criteria included abstract or manuscript written in English, published studies, conference abstracts, randomized controlled trials (RCTs), ciNPT usage over closed groin incisions in vascular surgery, comparison of ciNPT use and traditional dressings, study endpoint/outcome of surgical site infection, and study population of >10. Characteristics of study participants, surgical procedure, type of dressing used, duration of treatment, incidence of surgical site infection, and length of follow-up were extracted. Weighted odds ratios and 95% confidence intervals were calculated to pool study and control groups in each publication for analysis. Treatment effects were combined using Mantel-Haenszel risk ratios, and the Chi-Square test was used to assess heterogeneity. Overall, high-risk patients, normal-risk patients, and Szilagyi I, II, III outcomes were assessed between ciNPT and control groups. The Cochrane Collaboration tool was utilized to assess the risk of bias for all studies included in the analysis. Results A total of 615 articles were identified from the literature search. After removal of excluded studies and duplicates, six RCT studies were available for analysis. In these studies, a total of 362 patients received ciNPT, and 371 patients received traditional dressings (control). Surgical site infection events occurred in 41 ciNPT patients and 107 control patients. The heterogeneity test was nonsignificant ( p > 0.05). The overall RCT meta-analysis showed a highly significant effect in favor of ciNPT (OR = 3.06, 95% CI [2.05, 4.58], p < 0.05). High-risk, normal-risk, Szilagyi I, and Szilagyi II meta-analyses were also statistically significant in favor of ciNPT use ( p < 0.05). The varying RCT inclusion/exclusion criteria, such as differences in procedure types, and patient populations form the major limitations of this study. Conclusions A statistically significant reduction in the incidence of surgical site infection was seen following ciNPT usage in patients undergoing vascular surgery with groin incisions.

Surgical site infection risk following cesarean deliveries covered by Medicaid or private insurance

2019 ◽  
Vol 40 (6) ◽  
pp. 639-648 ◽  
Author(s):  
Sarah H. Yi ◽  
Kiran M. Perkins ◽  
Sophia V. Kazakova ◽  
Kelly M. Hatfield ◽  
David G. Kleinbaum ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Cesarean Delivery ◽  
Private Insurance ◽  
Site Infection ◽  
Cesarean Deliveries ◽  
Need To Evaluate ◽  
Study Population ◽  
Facility Level ◽  
Primary Payer

AbstractObjective:To compare risk of surgical site infection (SSI) following cesarean delivery between women covered by Medicaid and private health insurance.Study design:Retrospective cohort.Study population:Cesarean deliveries covered by Medicaid or private insurance and reported to the National Healthcare Safety Network (NHSN) and state inpatient discharge databases by hospitals in California (2011–2013).Methods:Deliveries reported to NHSN and state inpatient discharge databases were linked to identify SSIs in the 30 days following cesarean delivery, primary payer, and patient and procedure characteristics. Additional hospital-level characteristics were obtained from public databases. Relative risk of SSI by primary payer primary payer was assessed using multivariable logistic regression adjusting for patient, procedure, and hospital characteristics, accounting for facility-level clustering.Results:Of 291,757 cesarean deliveries included, 48% were covered by Medicaid. SSIs were detected following 1,055 deliveries covered by Medicaid (0.75%) and 955 deliveries covered by private insurance (0.63%) (unadjusted odds ratio, 1.2; 95% confidence interval [CI], 1.1–1.3; P < .0001). The adjusted odds of SSI following cesarean deliveries covered by Medicaid was 1.4 (95% CI, 1.2–1.6; P < .0001) times the odds of those covered by private insurance.Conclusions:In this, the largest and only multicenter study to investigate SSI risk following cesarean delivery by primary payer, Medicaid-insured women had a higher risk of infection than privately insured women. These findings suggest the need to evaluate and better characterize the quality of maternal healthcare for and needs of women covered by Medicaid to inform targeted infection prevention and policy.

scholarly journals Antibiotic Prophylaxis against Surgical Site Infection after Open Hernia Surgery: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Lolwah Al Riyees ◽  
Wedad Al Madani ◽  
Nistren Firwana ◽  
Hanan H. Balkhy ◽  
Mazen Ferwana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hernia Repair ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Meta Analysis ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Hernia Surgery ◽  
Significant Difference

<b><i>Objective:</i></b> The role of antibiotic prophylaxis (AP) in the prevention of surgical site infection (SSI) after hernia repair is debated. We conducted this systematic review and meta-analysis to assess the evidence on the value of prophylactic antibiotics in reducing the risks of SSI after open hernia surgery. <b><i>Methods:</i></b> We ran an online and manual search to identify relevant randomized controlled trials that compared prophylactic antibiotics to nonantibiotic controls in patients undergoing open surgical hernia repair. Data on SSI risk were extracted and pooled as risk ratios (RRs) with 95% confidence intervals (95% CIs), using RevMan software. We further used the Cochrane risk of bias tool and GRADE assessment to evaluate the quality of generated evidence. <b><i>Results:</i></b> Twenty-nine studies (<i>N</i> = 8,616 patients) were included in the current analysis. Antibiotic prophylaxis reduced the risk of SSI in open hernia repair patients (RR = 0.65, 95% CI = 0.53, 0.79). Subgroup analysis showed a significant benefit for antibiotics in mesh repair patients (RR = 0.60, 95% CI = 0.48, 0.76) yet no significant difference in SSI risk after herniorrhaphy (RR = 0.86, 95% CI = 0.54, 1.36). In addition, AP was associated with a significant reduction in superficial SSI risk (RR = 0.56, 95% CI = 0.43, 0.72) but not deep SSI (RR = 0.70, 95% CI = 0.30, 1.62). Further analysis showed a significant reduction in SSI risk with amoxicillin/clavulanic acid and cefazolin but not with cefuroxime. <b><i>Conclusion:</i></b> The present meta-analysis suggests that AP is beneficial prior to open mesh hernia repair. However, the quality of evidence was low, and further well-designed trials are needed.

The Relationship Between Bacteria and Breast Cancer: Focusing on the Common Staphylococcus aureus

2019 ◽  
Vol 9 (11) ◽  
pp. 1571-1574
Author(s):  
A. Na-Er ◽  
Yunhong Liu ◽  
Yanjun Gan
Keyword(s):  
Breast Cancer ◽  
Staphylococcus Aureus ◽  
Surgical Site Infection ◽  
Tnm Classification ◽  
Site Infection ◽  
The Common ◽  
One Year ◽  
The One ◽  
The Relationship

Background: The risk of post-operative infection still accounts for a high proportion among the patients. The peptidoglycan on Staphylococcus aureus promotes cellular invasiveness and adhesiveness of tumor cells by pathways activation, including NF-kB, STAT3 and Smad3. Methods: This study included 132 patients age ranging from 45–55 that have been diagnosed with IIA phase breast cancer based on the TNM classification system in one hospital located in the relatively high-income area. These patients have been scheduled the operations and are distributed into two groups: one group will be given certain dosage of antibiotics on presumed Staphylococcus aureus infections, and another group will not be given any unnecessary antibiotics before surgery. Results: We found that 6 patients present surgical site infection related Staphylococcus aureus, with 1 patient in the antibiotics group and the other 5 patients are in the non-antibiotics group. Within the one-year period after surgery, 4 patients presented with metastasis to adjacent lymph nodes, 3 patients are in the non-antibiotics group and another one in the antibiotics group. Conclusion: Early intervention could be an accessible method to decrease the incidence of surgical site infection, which has been illustrated in this study. We consider to take preventive dosage of antibiotics before surgery, which could improve the prognosis of breast cancer and their quality of life in a larger extent.

Validation of Surgical Site Infection Surveillance in The Netherlands

2007 ◽  
Vol 28 (1) ◽  
pp. 36-41 ◽  
Author(s):  
J. Manniën ◽  
A. E. van der Zeeuw ◽  
J. C. Wille ◽  
S. van den Hof
Keyword(s):  
Surgical Site Infection ◽  
Predictive Value ◽  
Medical Records ◽  
Surveillance System ◽  
Structured Interview ◽  
Surveillance Data ◽  
National Nosocomial Infection Surveillance ◽  
Site Infection ◽  
Infection Surveillance

Objectives.To describe how continuous validation of data on surgical site infection (SSI) is being performed in the Dutch National Nosocomial Infection Surveillance System (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), to assess the quality and accuracy of the PREZIES data, and to present the corresponding outcomes of the assessment.Design.Mandatory, 1-day on-site validation visit to participating hospitals every 3 years. The process of surveillance, including the quality of the method of data collection, is validated by means of a structured interview. The use of SSI criteria is validated by review of medical records, with the judgment of the validation team as the criterion standard.Setting.Hospitals participating in PREZIES.Results.During 1999-2004, the validation team visited 40 hospitals and reviewed 859 medical charts. There was no deviation between reports of SSI by infection control professionals and findings by the PREZIES validation team at 30 hospitals and 1 deviation in each of 10 hospitals; the positive predictive value was 0.97, and the negative predictive value was 0.99. The validation team often gave advice to the hospital, aimed at perfecting the process of surveillance. On 2 occasions, data were removed from the PREZIES database after the validation visit revealed deviations from the SSI surveillance protocol that could have resulted in nonrepresentative SSI rate data.Conclusions.PREZIES is confident that the assembled Dutch SSI surveillance data are reliable and robust and are sufficiently accurate to be used as a reference for interhospital comparison. PREZIES will continue performing on-site validation visits, to improve the process of surveillance and ensure the reliability of the surveillance data.

scholarly journals Surgical Site Infection Post Caesarean Section: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 1156-1159
Author(s):  
Hartati ◽  
Febi Stevi Aryani ◽  
M Satria Erlangga Sinum ◽  
Emasrissa Murwani
Keyword(s):  
Caesarean Section ◽  
Surgical Site Infection ◽  
Therapy Response ◽  
Major Complication ◽  
Prophylactic Antibiotics ◽  
Site Infection ◽  
Case Presentation ◽  
Laboratory Investigations ◽  
Complication Of Surgery

Background. Surgical site infection (SSI) is a major complication of surgery which can increase morbidity, mortality and cost of hospitality. Incidence of SSI at a healthcare provider/facility reflected a service quality of that institution. Case presentation. A 28-years-old woman, a housewife, P2A1, post-caesarean section 12 days ago. Pasien datang dengan keluhan utama badan lemas dan terdapat nanah pada luka bekas operasi. Ia mengeluh perutnya terasa semakin panas, dan keluar cairan bening sebelum muncul nanah pada luka operasi. Pasien juga mengeluh demam, mual dan lemas akhir-akhir ini Laboratory investigations showed Hb 11,9 g/dL, Leukosit 11.100 m/L, trombosit 601.000.  MCV 70,7 fL MCH 24 pg MCHC 32 g/dL TIBC 392 mg/dL serum Iron 54 mg/dL  Ferritin 19,8 ng/mL, CRP reactive. Patient was wound dressing and given levofloxacin 500mg three times a day intravascular for three days and continue with ciprofloxacin three time a day oral. Patient was suggest to repeat laboratory test after therapy to evaluate therapy response. Conclusion: The result showed that time of prophylactic antibiotics can used to minimize the occurrence of SSI in post-caesarean section patients.

scholarly journals Reducing Veterinary Waste: Surgical Site Infection Risk and the Ecological Impact of Woven and Disposable Drapes

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Molly Vasanthakumar
Keyword(s):  
Surgical Site Infection ◽  
One Health ◽  
Ecological Impact ◽  
Surgical Site Infections ◽  
Infection Risk ◽  
Site Infection ◽  
Veterinary Profession ◽  
Health Concept ◽  
The One

PICO questionIn animals undergoing surgery, does the use of disposable synthetic drapes reduce the risk of surgical site infections when compared to reusable woven drapes?Clinical bottom lineCurrent literature on the risk of surgical site infection with disposable and reusable drapes in animals is limited. Three human studies were reviewed, one systematic review and two controlled trials. Both these study types generally provide high levels of evidence; however their individual limitations reduce the quality of their data. Overall the results were mixed, and due to the small number of reviewed papers and the fact that only one study specifically measured surgical site infection as the outcome, it is not possible to conclude that disposable drapes reduce the risk of surgical site infections (SSI) when compared to reusable drapes.The impact of the veterinary profession on the ecosystem is often ignored. When following the One Health concept, vets must consider the ecological impact of clinical decisions. Choosing reusable drapes for certain clean, elective procedures may be a way to reduce waste without compromising the health of patients.

The Impact of Surgical Site Infection on Health-related Quality of Life: A Systematic Review

2021 ◽  
Vol 67 (6) ◽  
pp. 10-19
Author(s):  
Pinar Avsar ◽  
Declan Patton ◽  
Karen Ousey ◽  
Joanna Blackburn ◽  
Tom O'Connor ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Surgical Site Infection ◽  
Health Care Worker ◽  
Short Form ◽  
Site Infection ◽  
Patient Relationship ◽  
Care Worker ◽  
The Impact

BACKGROUND: Surgical site infection (SSI) is a common postoperative concern. PURPOSE: To provide an in-depth understanding of the lived experience and quality of life (QoL) of individuals with SSI. METHODS: A systematic search for published studies that explored the impact of SSI on QoL among adult patients (older than 18 years) who had undergone any type of surgery was performed in June 2020. The search included but was not limited to MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane databases using the terms “surgical site infection” OR “hospital-acquired infection” OR “nosocomial infection” OR “wound site infection” OR “surgical wound site infection” AND “Quality of Life” OR “Life quality” OR “Health-Related Quality of Life” OR “Life Style” OR “QOL” OR “HRQoL” OR “Short-form questionnaire 36” OR “Questionnaire SF-36” OR “SF-36.” All quantitative and qualitative study designs were included; no language or date of publication restrictions were imposed. The Critical Appraisal Skills Program Qualitative Checklist was used to assess the methodological quality of the included studies. Study author, date, setting, sample size, population, and design and type of surgery as well as QoL instrument scores were extracted. A narrative thematic synthesis, which comprised the physical, psychological, social, economic, and spiritual effects as well as the health care worker–patient relationship, was undertaken for qualitative studies. Outcome measures were collected and assessed using a range of established health QoL instruments and reported in terms of QoL for quantitative studies. In addition, the type of QoL instrument employed within the studies was elucidated for comparing the scores of the instruments. RESULTS: A total of 696 publications were found; 690 were eliminated, leaving 4 quantitative and 2 qualitative studies conducted between 2002 and 2018 that met the inclusion criteria. The total number of participants in the assessed studies was 785. The mean sample size for the included studies was 131 participants (SD = 192.5; median, 95). Thematic synthesis showed 6 overarching themes: physical, psychological, social, spiritual, and economic effects of SSI as well as the health care worker–patient relationship. Short Form-36 was used to assess QoL in 3 of the 4 quantitative studies; these studies showed that there were decrements in scores of Short Form-36. CONCLUSION: Although this systematic review included heterogeneous groups of patients who underwent different surgical procedures and completed different QoL assessment tools, patients with SSI experienced low QoL, with limitations in physical, social, and psychological functioning. The health care worker–patient relationship was predominantly perceived negatively. Further prospective research is warranted.

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