scholarly journals A clinical comparative retrospective cohort study in the surgical management of enteric perforation, by comparing primary closure and closure with free omental sheet graft

2017 ◽  
Vol 5 (1) ◽  
pp. 45
Author(s):  
Anantha Raju G. S.
Keyword(s):  
Surgical Site Infection ◽  
Primary Closure ◽  
Length Of Hospital Stay ◽  
Fecal Fistula ◽  
High Morbidity ◽  
Site Infection ◽  
Enteric Perforation ◽  
Group 2 ◽  
Sheet Graft ◽  
Group 1

Background: Typhoid ileal perforations have high morbidity and mortality rates irrespective of the type of surgeries performed. The aim of this study is to evaluate the morbidity, mortality and cost-effectiveness of a free omental sheet graft in perforated typhoid enteritis, in comparison with a primary ileal perforation closure.Methods: This study includes a total of 81 patients with enteric perforations in a span of 5 years from March 2009 to February 2014. The study was divided into two groups; group 1 included 40 cases in which primary enteric perforation closure was done and group 2 included 41 cases in which a free omental sheet graft was used in typhoid enteritis with perforation. The outcomes were measured in relation to various postoperative complications and mortality.Results: 90% of the patients in Group 1 had surgical site infection and 65% of the patients in Group 2 had surgical site infection. Intra-abdominal abscess was seen in 5% of the patients in Group 1, whereas no such morbidity was found in Group 2. 25% of the Group 1 patients had fecal fistula compared to none in Group 2. The mortality rate in Group 1 was 10% and no mortalities were seen in Group 2.Conclusions: Primary closure with free omental sheet graft has shown better results, compared to primary closure alone, in terms of morbidity, mortality and length of hospital stay, irrespective of the site of perforation.

Effect of Prophylactic Antibiotics in Orthopaedic Surgery

2021 ◽  
Vol 15 (11) ◽  
pp. 2969-2970
Author(s):  
Muhammad Siraj ◽  
Abbas Ali ◽  
Mudir Khan
Keyword(s):  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Orthopaedic Surgery ◽  
Prophylactic Antibiotics ◽  
Implant Removal ◽  
Diabetic Patients ◽  
Site Infection ◽  
Post Surgery ◽  
Group 2 ◽  
Group 1

Background: Orthopaedic surgeries require sensitive protocol for prevention of infection pre and post-surgery. Antibiotic-prophylaxis has been reported for reducing risk of infection in orthopaedic surgeries such as removal of implants. Aim: To assess the effect of prophylactic antibiotics in orthopaedic surgery. Study design: Retrospective study Place and duration of study: Dept. of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-1-2020 to 31-12- 2020. Methodology: One hundred and ten patients within 18-75 years were divided into two groups. Each group had 55 patients. Group 1 were given prophylactic antibiotics pre-operative as a single dose while group 2 were given only saline. All patients were admitted for removal of orthopaedic implants in foot, ankle or leg. Patients 30 days record was observed for any surgical-site infection. Results: The mean age of patient was 42.95±10.8 years. Group 1 and Group 2 had more males than females. There were 10.9% and 9.09% diabetic patients within group 1 and group 2. The 30 days assessment of post implant removal orthopaedic surgery showed a decrease of surgical-site infection in group 1. Surgical-site infection decreased by a rate of 5.4% among patients who were given cefazolin antibiotic. Conclusion: The effect of prophylactic antibiotic reduces chance of surgical-site infection in orthopaedic surgery. Keywords: Antibiotic-prophylaxis, Orthopaedic surgery, Implant-removal, Surgical-site infection

scholarly journals A single-dose antibiotic prophylaxis to prevent surgical site infection in clean-contaminated surgery among diabetic patients

2015 ◽  
Vol 1 (2) ◽  
pp. 8-10
Author(s):  
Kamal Koirala ◽  
Rupesh Mukhia ◽  
Suman Sharma ◽  
Sujan Manandhar ◽  
Niroj Banepali ◽  
...  
Keyword(s):  
Single Dose ◽  
Surgical Site Infection ◽  
Antibiotic Prophylaxis ◽  
Diabetic Patients ◽  
Outpatient Basis ◽  
Site Infection ◽  
Significant Difference ◽  
Group 2 ◽  
Clean Contaminated ◽  
Group 1

Introductions: Guidelines on antibiotics use in surgical patients recommends a single dose prophylaxis for clean-contaminated cases and therapeutic course for contaminated and dirty cases. Compliance to this guideline is poor among diabetic patients. The aim of this study was to test the efficacy of single dose antibiotic prophylaxis on the occurrence of postoperative surgical site infection (SSI) in clean-contaminated surgery in diabetic patients.Methods: Retrospective cross-sectional study was carried out at KIST Medical College and Teaching Hospital from September 2008 to August 2012 involving 144 diabetic patients who underwent major clean-contaminated surgery. Forty eight patients received one gram of ceftriaxone intravenously as prophylactic antibiotic within 30 minutes prior to incision (group 1) and 96 patients received three doses of ceftriaxone (group 2). One dose was given within 30 minutes prior to incision and other two doses were given postoperatively. All patients were followed up for 30 postoperative days on outpatient basis. The SSI rates were compared in two groups. Pus from the infected wound was tested for culture and sensitivity.Results: The SSI rates in group 1 and group 2 were of 5/48 (10.42%) and of 9/96 (9.37%) respectively. There was no significant difference in SSI rates between group 1 and group 2 (p=0.322).Conclusions: Single dose of Ceftriaxone shows the similar effect as three doses in clean-contaminated surgery in diabetic patients.

scholarly journals Comparing SSI In Purse-String Versus Conventional Primary Closure Following Stoma Reversal

Esculapio ◽  
2021 ◽  
Vol 17 (1) ◽  
pp. 15-19
Author(s):  
Sabih Nofal ◽  
Anum Arif ◽  
Ahsan Khan ◽  
Sundus Saif ◽  
Abdul Waheed Khan ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Hospital Stay ◽  
Primary Closure ◽  
Length Of Hospital Stay ◽  
P Value ◽  
Site Infection ◽  
Purse String ◽  
Stoma Reversal ◽  
Group A ◽  
Group B

Objective: To compare the frequency of Surgical Site Infection ( SSI ) and mean length of hospital stay between the Purse-string closure and conventional primary closure techniques for stoma reversal. Methods: The study was carried out in Surgical Unit-III, Lahore General Hospital Lahore from January 5, 2018 to July 5, 2018. The study designed as a Observational Study. Patients undergoing surgery for Ileostomy were randomly divided into two groups, Group-A (Purse-string closure) and Group-B (Conventional primary closure). All the patients were called for follow up checkup on 14th days after operation and after one month. Both of the groups were checked and recorded for SSI after operation and hospital stay. The data was statistically analyzed by using SPSS v23.0.t test (independent sample) used for the comparison of hospital stay mean. Chi-square was also used for the comparison of the frequencies of SSI. Data were stratified for gender and age. A p-value ≤0.05 was considered as significant. Results: A total of 140 patients were enrolled for this study. Patients were divided into two groups i.e. Group- A (Purse-string closure) and Group-B (Conventional primary closure). In group-A, mean duration of hospital stay was 5.7±1.0 days, while 7.3±1.1 days in group-B, which is statistically significant with a p-value of 0.000. In group-A, surgical site infection was in 4(5.7%) patients, while 11(15.7%) patients of group-B, which is statistically significant with a p-value of 0.046. Conclusion: The frequency of surgical site infection and mean length of hospital stay after stoma reversal, purse-string suturing technique is significantly less than conventional primary closure technique. Key Words: Surgical stoma; Ileostomy; Closure; Infection. How to cite: Nofal S., Arif A., Khan A., Saif. S., Khan W.A., Arif A. Comparing SSI in Purse-String Versus Conventional Primary Closure Following Stoma Reversal. Esculapio 2021; 17(01): 15-19

scholarly journals Arthroplasty infection rates in fractured neck of femur: single vs dual antibiotic cement

2019 ◽  
Vol 101 (7) ◽  
pp. 514-518 ◽  
Author(s):  
P Savage ◽  
M McCormick ◽  
O Al-Dadah
Keyword(s):  
Surgical Site Infection ◽  
Infection Rate ◽  
Site Infection ◽  
Surgical Site Infection Rate ◽  
Fractured Neck Of Femur ◽  
Neck Of Femur ◽  
Antibiotic Cement ◽  
Deep Surgical Site Infection ◽  
Group 2 ◽  
Group 1

Introduction Mortality rates following hip arthroplasty range between 10% and 40% after 12 months. A higher rate is attributed to postoperative complications, of which surgical site infection is one of the most significant. In an effort to reduce surgical site infection following arthroplasty, antibiotics can be added to the cement used. The primary aim of this study was to determine whether dual antibiotic impregnated cement can reduce the rate of deep surgical site infection in patients following cemented arthroplasty for fractured neck of femur compared with single antibiotic impregnated cement. The secondary aim was to compare the rate of superficial surgical site infection in single compared with dual antibiotic cement. Materials and methods A total of 206 patients were included. Group 1 included 108 retrospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using single antibiotic impregnated cement. Group 2 included 98 prospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using dual antibiotic impregnated cement. The rates of deep and superficial surgical site infection were investigated. Results Group 1 had a deep surgical site infection rate of 2.9% (n = 3), Group 2 had a deep surgical site infection rate of 0% (n = 0). Group 1 had a superficial surgical site infection rate of 3.7% (n = 4), Group 2 had a superficial surgical site infection rate of 5.1% (n = 5). Conclusion Dual antibiotic cement reduced the rate of deep surgical site infection compared with conventional single antibiotic cement in arthroplasty for fractured neck of femur. Only a marginal difference in superficial surgical site infection was observed.

Clinical outcome of V-Y flap with latissimus dorsi and gluteal advancement for treatment of large thoracolumbar myelomeningocele defects: a comparative study

2019 ◽  
Vol 24 (1) ◽  
pp. 75-84
Author(s):  
Mohammad Sadegh Masoudi ◽  
Mohammad Ali Hoghoughi ◽  
Fariborz Ghaffarpasand ◽  
Shekoofeh Yaghmaei ◽  
Maryam Azadegan ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Comparative Study ◽  
Surgical Site Infection ◽  
Latissimus Dorsi ◽  
Primary Closure ◽  
Wound Dehiscence ◽  
Site Infection ◽  
Gluteal Muscle ◽  
Operative Duration ◽  
Csf Leakage

OBJECTIVESurgical repair and closure of myelomeningocele (MMC) defects are important and vital, as the mortality rate is as high as 65%–70% in untreated patients. Closure of large MMC defects is challenging for pediatric neurosurgeons and plastic surgeons. The aim of the current study is to report the operative characteristics and outcome of a series of Iranian patients with large MMC defects utilizing the V-Y flap and with latissimus dorsi or gluteal muscle advancement.METHODSThis comparative study was conducted during a 4-year period from September 2013 to October 2017 in the pediatric neurosurgery department of Shiraz Namazi Hospital, Southern Iran. The authors included 24 patients with large MMC defects who underwent surgery utilizing the bilateral V-Y flap and latissimus dorsi and gluteal muscle advancement. They also retrospectively included 19 patients with similar age, sex, and defect size who underwent surgery using the primary or delayed closure techniques at their center. At least 2 years of follow-up was conducted. The frequency of leakage, necrosis, dehiscence, systemic infection (sepsis, pneumonia), need for ventriculoperitoneal shunt insertion, and mortality was compared between the 2 groups.RESULTSThe bilateral V-Y flap with muscle advancement was associated with a significantly longer operative duration (p < 0.001) than the primary closure group. Those undergoing bilateral V-Y flaps with muscle advancement had significantly lower rates of surgical site infection (p = 0.038), wound dehiscence (p = 0.013), and postoperative CSF leakage (p = 0.030) than those undergoing primary repair. The bilateral V-Y flap with muscle advancement was also associated with a lower mortality rate (p = 0.038; OR 5.09 [95% CI 1.12–23.1]) than primary closure. In patients undergoing bilateral V-Y flap and muscle advancement, a longer operative duration was significantly associated with mortality (p = 0.008). In addition, surgical site infection (p = 0.032), wound dehiscence (p = 0.011), and postoperative leakage (p = 0.011) were predictors of mortality. Neonatal sepsis (p = 0.002) and postoperative NEC (p = 0.011) were among other predictors of mortality in this group.CONCLUSIONSThe bilateral V-Y flap with latissimus dorsi or gluteal advancement is a safe and effective surgical approach for covering large MMC defects and is associated with lower rates of surgical site infection, dehiscence, CSF leakage, and mortality. Further studies are required to elucidate the long-term outcomes.

scholarly journals ROLE OF PREOPERATIVE ASSESSMENT OF SERUM CHOLESTEROL AND ALBUMIN IN SURGICAL SITE INFECTION.

2019 ◽  
Vol 3 (7) ◽  
Author(s):  
Dr. Kirankumar B. Sodavadiya ◽  
Dr. Sunita Singh ◽  
Dr. BK Agrawal
Keyword(s):  
Relative Risk ◽  
Surgical Site Infection ◽  
Length Of Hospital Stay ◽  
Preoperative Assessment ◽  
Albumin Level ◽  
Blood Cholesterol ◽  
Site Infection ◽  
Health Care Centre ◽  
The People ◽  
Study Population

INTRODUCTION:Surgical site infection (SSI) is defined as infection occurring in an incisional wound within 30 days of the procedure or within 1 year if a prosthesis is implanted. A few studies have reported a relationship between low serum albumin level and low cholesterol level in surgical site infection, length of hospital stay and death and is reported to be one of the major causes of morbidity and mortality among hospitalized patients. METHOD:1 year prospective cohort study was conducted in Tertiary Health care Centre, Indore. A study population of 248 patients from hospital admitted in Department of General Surgery for elective operation. RESULT:From Total Patients - 172 (69.4%) were male patients and 76 (30.6%) were female patients. The frequency of patients developed SSI in hypoalbuminemia was 25(44.6%) in number compare to n=18(10.7%) in normal and to n= 03(12.5%) in hyper albuminemia. The Relative Risk between Hypoalbuminemia and SSI is 4.17 with CI (2.46  to 7) (P = <0.001). There is a significant association between cholesterol levels and the occurrence of SSI, with majority of the people with SSI had Hypocholesterolemia and it was found to be statistically significant with Relative risk(RR=3.98, CI= 2.28 to 6.95) (P = <0.001). CONCLUSION:Low blood cholesterol and albumin level are the important factors which is usually can lead to significant decrease in this preventable post operative complications especially in a malnourished population presenting in a government setup.

Abstract WP284: Pro-inflammatory Response Elicited by Porphyromonas Gingivalis Lipopolysaccharide Exacerbates the Rupture of Experimental Cerebral Aneurysms

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Takeshi Miyamoto ◽  
Keiko T Kitazato ◽  
Yoshiteru Tada ◽  
Kenji Shimada ◽  
Kenji Yagi ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Porphyromonas Gingivalis ◽  
Intracranial Aneurysms ◽  
Renal Hypertension ◽  
Saline Control ◽  
High Morbidity ◽  
Aneurysmal Rupture ◽  
Porphyromonas Gingivalis Lipopolysaccharide ◽  
Group 2 ◽  
Group 1

Introduction: Subarachnoid hemorrhage (SAH) is a catastrophic event with high morbidity and a poor prognosis. To prevent SAH, its pathogenesis must be understood. Dental infection may play a part in the pathophysiology of intracranial aneurysms. In our newly established rat model of aneurysms, the vascular inflammatory response was associated with their rupture. Therefore we hypothesized that the inflammatory response exacerbated by periodontal pathogens affects experimental cerebral aneurysm rupture. Methods: Aneurysms were induced in 10-week-old female Sprague-Dawley rats by eliciting estrogen deficiency, renal hypertension, and hemodynamic stress. Two weeks later they were divided into 2 groups; group 1 (n=13) was treated with Porphyromonas gingivalis lipopolysaccharide (LPS), group 2 (n=17) was the saline control. Both groups were intraperitoneally injected once a week. Results: During the 90-day observation period, 7 group 1 (54%) and 6 group 2 rats (35%) suffered aneurysmal rupture. The incidence of rupture within 60 days was significantly higher in group 1 than group 2 (38% vs 6%, p<0.05), indicating that LPS promoted experimental aneurysmal rupture. The administration of LPS increased the plasma level of IL-1β and MMP-9 and the mRNA level of TLR2, IL-1β, and MMP-9 in the vascular wall prone to rupture on day 60. In our in vitro studies, IL-1β mRNA was increased in vascular smooth muscle cells exposed to LPS. These results suggest that LPS enhances the rupture of intracranial aneurysms via the promotion of local and systemic pro-inflammatory responses. Conclusion: Our study first documents that in rats, Porphyromonas gingivalis LPS exacerbates vascular inflammation and enhances the rupture of intracranial aneurysms.

Abstract WP380: Thyrotoxicosis is Associated With Worse In-Hospital Mortality in Patients With Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sakiru O Isa ◽  
Olajide Buhari ◽  
Hameem Changezi
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
The Body ◽  
Significant Difference ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
Time Of Presentation ◽  
Group 1

Introduction: Hyperthyroidism increases the basal metabolic rate and affects most systems in the body. Patients with hyperthyroidism have been shown to have a higher incidence of ischemic stroke. There is a paucity of information regarding its effects on the short-term outcomes of patients admitted with ischemic stroke. Hypothesis: Hyperthyroidism is associated with worse in-hospital outcomes in patients admitted for ischemic stroke. Methods: We queried the National Inpatient Sample to identify adult patients(aged 18 and above) admitted for ischemic stroke between January 2011 and December 2014. We compared those with a history of hyperthyroidism (group 1) and thyrotoxicosis on admission (group 2) with the rest of the patients (group 3). The main outcome was in-hospital mortality. Secondary outcomes included the length of hospital stay and cost of hospitalization. We used the logistic regression model and adjusted for baseline characteristics and co-morbidities. Results: There were 643,786 patients in the study, 0.44% had a history of hyperthyroidism, and 0.01% had thyrotoxicosis at the time of presentation. The odd of mortality in group 1 compared to group 3 was 0.89, 95% CI 0.75-1.05, p=0.16 while in group 2 compared to group 3, it was 2.42, 95% CI 1.29-4.52, p<0.006. The mean length of stay was also longer in group 2 with a mean difference of 8.06, 95% CI 4.74 - 11.39, p<0.0001. Conclusion: From the study, there was no significant difference in in-hospital mortality between patients with previously diagnosed hyperthyroidism and those without diagnosed hyperthyroidism. Patients who had thyrotoxicosis on admission, on the other hand, had worse outcomes compared to patients without thyrotoxicosis.

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