scholarly journals Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study

2022 ◽  
Vol 11 ◽  
pp. 3
Author(s):  
Hyginus Okechukwu Ekwunife ◽  
Emmanuel Ameh ◽  
Lukman Abdur-Rahman ◽  
Adesoji Ademuyiwa ◽  
Emem Akpanudo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Surgical Site Infection ◽  
Postoperative Complication ◽  
Outcome Measure ◽  
Postoperative Mortality ◽  
Sub Saharan Africa ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Complication Rates ◽  
Site Infection

Background:  Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes.  Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates. Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (p <0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9).  Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.

scholarly journals O4 Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Samuel Lawday ◽  
Isobel Trout
Keyword(s):  
Cohort Study ◽  
Outcome Measure ◽  
Elective Surgery ◽  
Postoperative Mortality ◽  
Postoperative Recovery ◽  
Pulmonary Complications ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Complication Rates ◽  
The Impact

Abstract Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery is poorly understood. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality. The secondary outcome measure was pulmonary complications (pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation). Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p &lt; 0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p &lt; 0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p &lt; 0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p = 0·046), emergency versus elective surgery (1·67 [1·06–2·63], p = 0·026), and major versus minor surgery (1·52 [1·01–2·31], p = 0·047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than normal practice, particularly in men aged 70 years and older.

scholarly journals Evaluation of a bundle of care to reduce incisional surgical site infection after gastrointestinal surgery

2019 ◽  
Vol 21 (2) ◽  
pp. 52-59
Author(s):  
Liam Phelan ◽  
Mark P Dilworth ◽  
Aneel Bhangu ◽  
Jack W Limbrick ◽  
Stratton King ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Outcome Measure ◽  
Gastrointestinal Surgery ◽  
Secondary Outcome ◽  
Evidence Based ◽  
Secondary Outcome Measure ◽  
Site Infection ◽  
Post Intervention ◽  
Group 3 ◽  
Group 2

Background: Surgical site infection (SSI) is associated with morbidity, mortality and increased care costs; many SSIs are considered preventable. The aim of the present study was to test implementation of a pragmatic, evidence-based bundle designed to reduce incisional SSI after emergency laparotomy and elective major lower gastrointestinal surgery. Method: This was a prospective before-and-after study. Data were collected before the intervention and for two separate subsequent time periods. An evidence-based bundle of care (BOC) was implemented; the primary outcome measure was incisional SSI at 30 days. The secondary outcome measure was 30-day unplanned readmissions. The initial post-intervention group, Group 2, assessed a variable number of potential impacting factors; however, due to funding and staffing levels the second post-bundle group, Group 3, focused on the core aspects of the BOC and rates of incisional SSI and readmission. Results: In total, 99 patients were included in the ‘before’ group; and 71 in Group 2 and 92 in Group 3, the post-intervention groups. The incisional SSI rate was 29.3% (29/99) before and 28.2% (20/71) in Group 2 ( P=0.873) and 21.7% (20/92) in Group 3 ( P=0.234) after the intervention. After adjustment for confounders, the care bundle was associated with a non-significant reduction in SSI (Group 2: odds ratio [OR] = 0.93, 95% confidence interval [CI] = 0.45–1.93, P=0.0843). However, it was associated with significantly reduced readmissions 18.1% (18/99) before versus 5.6% (4/71) in Group 2 (OR = 0.236, 95% CI = 0.077–0.72, P=0.012) and 8.7% (8/92) in Group 3 (OR = 0.38, 95% CI = 0.16–0.9, P=0.029). Comparing the pre-bundle group to the post-bundle groups, there was an overall significant reduction in readmissions ( P=0.003). This implies a number needed to treat of 8–11 patients to prevent one readmission. Adherence to antibiotic prophylaxis with the Trust guidelines increased from 91% to 99% (1 vs. 2, P=0.047). Conclusion: Introduction of the bundle was associated with a reduction in the observed rate of incisional SSI from 29.3% to 21.7%; significantly fewer patients required unplanned readmission. Use of the bundle was associated with significantly improved compliance with appropriate antimicrobial prophylaxis.

scholarly journals Determining universal processes related to best outcome in emergency abdominal surgery: a multicentre, international, prospective cohort study

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e006239 ◽  
Author(s):  
Aneel Bhangu ◽  
J Edward Fitzgerald ◽  
Stuart Fergusson ◽  
Chetan Khatri ◽  
Hampus Holmer ◽  
...  
Keyword(s):  
Cohort Study ◽  
Abdominal Surgery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Perioperative Mortality ◽  
Acute Surgery ◽  
Emergency Abdominal Surgery

IntroductionEmergency abdominal surgery outcomes represent an internationally important marker of healthcare quality and capacity. In this study, a novel approach to investigating global surgical outcomes is proposed, involving collaborative methodology using ‘snapshot’ clinical data collection over a 2-week period. The primary aim is to identify internationally relevant, modifiable surgical practices (in terms of modifiable process, equipment and clinical management) associated with best care for emergency abdominal surgery.Methods and analysisThis is a multicentre, international, prospective cohort study. Any hospital in the world performing acute surgery can participate, and any patient undergoing emergency intraperitoneal surgery is eligible to enter the study. Centres will collect observational data on patients for a 14-day period during a 5-month window and required data points will be limited to ensure practicality for collaborators collecting data. The primary outcome measure is the 24 h perioperative mortality, with 30-day perioperative mortality as a secondary outcome measure. During registration, participants will undertake a survey of available resources and capacity based on the WHO Tool for Situational Analysis.Ethics and disseminationThe study will not affect clinical care and has therefore been classified as an audit by the South East Scotland Research Ethics Service in Edinburgh, Scotland. Baseline outcome measurement in relation to emergency abdominal surgery has not yet been undertaken at an international level and will provide a useful indicator of surgical capacity and the modifiable factors that influence this. This novel methodological approach will facilitate delivery of a multicentre study at a global level, in addition to building international audit and research capacity.Trial registration numberThe study has been registered with ClinicalTrials.gov (Identifier: NCT02179112).

scholarly journals Complications after surgery for benign prostatic enlargement: a population-based cohort study in Ontario, Canada

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032170
Author(s):  
Rano Matta ◽  
Erind Dvorani ◽  
Christopher Wallis ◽  
Amanda Hird ◽  
Joseph LaBossiere ◽  
...  
Keyword(s):  
Cohort Study ◽  
Postoperative Complication ◽  
Medical Therapy ◽  
Population Based ◽  
Secondary Outcome ◽  
Complication Rates ◽  
Benign Prostatic Enlargement ◽  
Specific Event ◽  
Prostatic Enlargement ◽  
Event Rates

ObjectivesTo examine the complication rates after benign prostatic enlargement (BPE) surgery and the effects of age, comorbidity and preoperative medical therapy.DesignA retrospective, population-based cohort study using linked administrative data.SettingOntario, Canada.Participants52 162 men≥66 years undergoing first BPE surgery between 1 January 2003 to 31 December 2014.InterventionMedical therapy preoperatively and surgery for BPE.Primary and secondary outcome measuresThe primary outcome was overall 30-day postoperative complication rates. Secondary outcomes included BPE-specific event rates (bleeding, infection, obstruction, trauma) and non-BPE specific event rates (cardiovascular, pulmonary, thromboembolic and renal). Multivariable analysis examined the association between preoperative medical therapy and postoperative complication rates.ResultsThe 30-day overall complication rate after BPE surgery was 2828 events/10 000 procedures and increased annually over the study period. Receipt of preoperative α-blocker monotherapy (relative rate (RR) 1.05; 95% CI 1.00 to 1.09; p=0.033) and antithrombotic medications (RR 1.27; 95% CI 1.22 to 1.31; p<0.0001) was associated with increased complication rates. Among the ≥80-year-old group, the rate of complications increased by 39% from 2003 to 2014 (RR 1.39; 95% CI 1.21 to 1.61; p<0.0001). The mean duration of medical and conservative management increased by a mean of 2.1 years between 2007 and 2014 (p<0.0001 for trend).ConclusionsThirty-day complication rates after BPE surgery have increased annually between 2003 and 2014. Preoperative medical therapy with alpha blockers or antithrombotics was independently associated with higher rates of complications. Over this time, the duration of conservative therapy also increased.

scholarly journals Trajectories of sickness absence after road traffic injury: a Swedish register-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e031132 ◽  
Author(s):  
Ritva Rissanen ◽  
Yajun Liang ◽  
Jette Moeller ◽  
Alicia Nevriana ◽  
Hans-Yngve Berg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Return To Work ◽  
Sickness Absence ◽  
Injury Severity ◽  
Outcome Measure ◽  
Road Traffic ◽  
Road Traffic Injury ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Traffic Injury

ObjectivesDespite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns’ interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity.DesignA register-based prospective cohort study.SettingAdministrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data.ParticipantsIndividuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included.Primary and secondary outcome measuresThe primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL.ResultsThree distinct patterns of SA were identified; ‘Stable’, ‘Quick decrease’ and ‘Gradual decrease’. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable.ConclusionThe study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.

Safety of Large Volume Liposuction in Aesthetic Surgery: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Muholan Kanapathy ◽  
Marc Pacifico ◽  
Ahmed M Yassin ◽  
Edward Bollen ◽  
Afshin Mosahebi
Keyword(s):  
Systematic Review ◽  
Large Volume ◽  
Outcome Measure ◽  
Surgical Complication ◽  
Major Complication ◽  
Current Data ◽  
Current Evidence ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Complication Rates

Abstract Background Current literature clearly outlines the complication rates of liposuction in general, however data specific to large-volume liposuction (LVL) remains unclear. Objectives This systematic review aims to synthesize the current evidence on the safety of LVL. Methods A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted for primary clinical studies reporting on safety or complications related to aesthetic LVL from 1946 to March 2020. The primary outcome measure was the incidence of surgical complication while the secondary outcome measure was changes in metabolic profile. Meta-analyses were conducted to pool the estimated surgical complication incidence and metabolic changes. Results Twenty-three articles involving 3583 patients were included. The average aspirate volume was 7,734.90ml (95%CI=5727.34ml to 9742.45ml). The pooled overall incidence of major surgical complications was 3.35% (95%CI=1.07% to 6.84%). The most common major complication was blood loss requiring transfusion (2.89% (95%CI=0.84% to 6.12%)) followed by pulmonary embolism (0.18% (95%CI=0.06% to 0.33%)), hematoma (0.16% (95%CI=0.05% to 0.32%)), necrotizing fasciitis (0.13% (95%CI=0.04% to 0.29%)), and deep vein thrombosis (0.12% (95%CI=0.03% to 0.27%)). No fat embolism or death was reported in the included studies. The pooled overall incidence of minor surgical complication was 11.62% (95%CI=6.36% to 18.21%), with seroma being the commonest minor complication (5.51% (95%CI=2.69% to 9.27%)). Reductions in lipid profile, glucose profile, body weight and hematocrit level were observed after LVL. Conclusions This study meta-analyzed and highlighted the complication rates specifically related to LVL, however the current data is limited by the lack of Level 1 evidence.

scholarly journals Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Ethiopia: a prospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Gemedo Misha ◽  
Legese Chelkeba ◽  
Tsegaye Melaku
Keyword(s):  
Escherichia Coli ◽  
Cohort Study ◽  
Surgical Site Infection ◽  
Prospective Cohort Study ◽  
Antimicrobial Susceptibility ◽  
Prospective Cohort ◽  
Site Infection ◽  
Gram Negative ◽  
Tertiary Teaching ◽  
Susceptibility Patterns

Abstract Background Globally, surgical site infections are the most reported healthcare-associated infection and common surgical complication. In developing countries such as Ethiopia, there is a paucity of published reports on the microbiologic profile and resistance patterns of an isolates. Objective This study aimed at assessing the bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at Jimma Medical Center in Ethiopia. Methods A prospective cohort study was employed among adult patients who underwent either elective or emergency surgical procedures. All the eligible patients were followed for 30 days for the occurrence of surgical site infection (SSI). From those who developed SSI, infected wound specimens were collected and studied bacteriologically. Results Of 251 study participants, 126 (50.2%) of them were females. The mean ± SD age of the patients was 38 ± 16.30 years. The overall postoperative surgical site infection rate was 21.1% and of these 71.7% (38/53) were culture positive. On gram stain analysis, 78% of them were Gram-negative, 11.5% were Gram-positive and 10.5% were a mixture of two microbial growths. Escherichia coli accounted for (21.43%), followed by Pseudomonas aeruginosa (19.05%), Proteus species (spp.) 14.29%), Staphylococcus aureus (11.90%), Klebsiella species (11.90%), Citrobacter spp. (9.5%), streptococcal spp. (7.14%), Coagulase-negative S. aureus (CoNS) (2.38%) Conclusion Gram-negative bacteria were the most dominant isolates from surgical sites in the study area. Among the Gram-negative bacilli, Escherichia coli were the most common bacteria causing surgical site infection. As there is high antibiotic resistance observed in the current study, it is necessary for routine microbial analysis of samples and their antibiogram.

Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance

2021 ◽  
pp. 019459982110487
Author(s):  
Mohamed Abdelwahab ◽  
Sandro Marques ◽  
Isolde Previdelli ◽  
Robson Capasso
Keyword(s):  
Surgical Site Infection ◽  
Hospital Readmission ◽  
Antibiotic Prescription ◽  
Postoperative Bleeding ◽  
Upper Airway ◽  
National Database ◽  
Complication Rates ◽  
Site Infection ◽  
Tertiary Referral Center ◽  
Obstructive Sleep

Objective Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. Study Design Retrospective cohort (national database). Setting Tertiary referral center. Methods This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. Results A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery ( P < .001, P < .001, and P = .006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission ( P < .001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. Conclusions Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.

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