Preoperative considerations for peripheral nerve stimulation of the sacroiliac joint

This chapter reviews preoperative factors to be considered before performing peripheral nerve stimulation of the sacroiliac joint. When designing a preoperative plan, it is important to consider the type of anesthesia to be administered, anticoagulation management, infection risk, and other relevant medical comorbidities that may complicate the procedure. These factors vary depending on the patient, and in many cases coordination with other specialists is required. Optimization of patient comorbidities, appropriate management of anticoagulation, and planning strategies to minimize infection risk (including the use of perioperative antibiotics) are paramount to ensure the best possible outcomes for the patient undergoing this procedure.

Evaluation of post-operative complications after mastectomy performed without perioperative antimicrobial prophylaxis in dogs

Background Mastectomy is the most common procedure for treatment of mammary tumours. Dogs undergoing mastectomy have a risk of developing surgical site infections (SSI) and other postoperative complications. However, potential risk factors associated with such complications have been sparsely investigated. Thus, the objective of this retrospective study was to determine the incidence of, and identify risk factors for, SSI and non-SSI postoperative complications after mastectomy performed without perioperative antimicrobial prophylaxis in privately owned otherwise clinically healthy dogs. Results Medical records were reviewed retrospectively for 135 client-owned female dogs, 10–35 kg in weight and three to 10 years of age, which had undergone mastectomy due to mammary tumours at three referral animal hospitals in Sweden over a 3-year period. Twelve (8.9%) dogs developed SSI, and 21 dogs (17.1%) dogs suffered a non-SSI postoperative complication. The incidence of SSI and all complications (SSI and non-SSI) were higher in dogs that had two to three (SSI: P = 0.036 and all complications: P = 0.0039) and four to five (SSI and all complications: P = 0.038) mammary glands excised, compared to dogs that had one mammary gland excised. The incidence of SSI was 1.7% (n = 1/60) in dogs that had one gland removed. The incidence of non-SSI postoperative complications was higher in dogs with a higher body weight (P = 0.02). Conclusions The incidence of SSI was lower than or similar to previously reported incidences of SSI in dog populations that have undergone tumour excisional surgery, despite the fact that dogs in the present study had not received perioperative antibiotics. Dogs that had two or more glands excised had an increased risk of developing SSI and non-SSI complications compared to dogs that had one gland excised. Furthermore, higher BW was associated with an increased risk of non-SSI complications. Results from the study indicate that routine use of perioperative antibiotics in tumour excisional surgery can be questioned, at least in single gland mastectomy in otherwise clinically healthy dogs.

Assessment of perioperative antibiotic prophylaxis for gynecological surgeries at an academic hospital in Brazil

The aim of this study was to assess the adequacy of physicians' practice patterns regarding the use of perioperative antibiotic prophylaxis for gynecological surgeries in an academic hospital specialized in gynecology located at Rio de Janeiro city, Brazil. This is a retrospective study assessing all gynecological surgeries performed over one year. Appropriateness of antibiotic prophylaxis was determined according to criteria adapted from evidence-based guidelines. Clinical practice regarding the use of perioperative antibiotic prophylaxis was considered appropriate for 58.4% of 416 surgeries. The non-indicated use of antimicrobial prophylaxis was the main factor determining the low percentage of overall adequacy. Three variables were independently associated with inappropriate administration of perioperative antibiotics: patients age, breast surgeries and longer procedures. Antibiotic prophylaxis compliance to published recommendations is low. Women undergoing gynecological surgery are exposed to unnecessary risks associated to non-indicated use of antibiotic prophylaxis. Strategies aimed to improve compliance to evidence-based guidelines are necessary.

Shunt Infection

The improvement in the management of hydrocephalus comes from the following: early diagnosis, radiological investigation, better knowledge of mechanisms, quality of material, surgical technique of implantation, less shunt complications (e.g.infections) and alternatives to shunt (e.g. Neuroendoscopy). However, shunt infection does not improve in the last decades, ranging from 3 to 12%. Shunt infection can be classified in: would infection, CSF infection, infected shunt system, abdominal complications (infection). The main agent is Staphylococcus, causing 67%-85% of problems, mainly due to colonization of shunt by skin flora. The majority of cases occur during the first 2 months (85%), late infection is rare. Risk factors to infection are the following: the cause of hydrocephalus, clinical condition and the age of children, operation time of the day, the duration of the shunt operation, the number of persons in OR, shunt material (Antibiotic catheter), presence of previously shunt system, postoperative CSF leak, perioperative antibiotics and economic level of Medical Center. Recommended management of shunt infection: removal of the shunt, insertion of an external drainage (EVD) (always in operation room), change EVD after 15 days, intravenous antibiotics, replacement of ventriculoperitoneal shunt after 3 sterile cultures. The most feared complications of Shunt infection are mortality, morbidity and cost. In conclusion: SHUNT INFECTION IS NOT A FATALITY

Administration of Single-Dose Antibiotic Does Not Decrease Oronasal Fistula Rates After Primary Palatoplasty

Objective: Oronasal fistula (ONF) is a known complication after primary palatoplasty (PP). Studies investigating the effect of perioperative antibiotics on fistula rates after PP are limited by inadequate sample size or reliance on self-reporting through national databases. In this study, the authors evaluated the association between single-dose perioperative antibiotics and postoperative fistula rates after PP at a single institution. Design: A retrospective study. Participants: Children younger than 2 years who underwent PP from April 2009 to September 2019 were included. Interventions: Patients were divided into 2 categories: Group 1 received a single intraoperative dose of IV antibiotic, while group 2 did not. Main Outcome Measure(s): Outcome measures included ONF formation, length of stay (LOS), and 30-day readmission rates. Multivariable firth logistic regression, quantile regression, and χ2 tests were performed. Results: Of the 424 patients, 215 and 209 patients were in groups 1 and 2, respectively. The overall ONF rate was 1.9% among all patients. Patients in group 1 experienced an ONF rate of 3.3%, while patients in group 2 had an ONF rate of 0.5%. After correcting for confounding variables, the difference in ONF rates was not statistically different ( P = .68). Median LOS was 35.7 hours and 35.5 hours ( P = .17), while the rate of readmission within 30 days was 4.7% and 2.4% for group 1 and 2, respectively ( P = .96). Conclusions: Administration of a single-dose perioperative antibiotic did not decrease fistula formation after PP, nor did it affect the patient’s LOS or 30-day readmission rate.

Same-Day Versus Next-Day Dexamethasone Intracanalicular Insert Administration for Inflammation and Pain Control Following Cataract Surgery: A Retrospective Analysis

Background: The dexamethasone 0.4mg intracanalicular insert (Dextenza, Ocular Therapeutix, Bedford, MA) is approved for control of postoperative pain and inflammation following ocular surgery. This study compared pain and inflammation resolution following phacoemulsification in eyes that received the insert immediately postoperatively versus the next day.Methods: This was a retrospective analysis of existing electronic health records. Consecutive qualifying eyes were included for analysis. All patients received perioperative antibiotics and nonsteroidal anti-inflammatory drugs. Pain and inflammation were assessed at baseline and on postoperative days 1, 7, and 30. Pain was assessed by dichotomous patient report (present/absent). Anterior chamber cell (0, 0.5+, 1-4+) and flare (0-4+) were graded using the Standardization of Uveitis Nomenclature rubric. Results: Data from 17 eyes of 17 subjects were analyzed; 8 received the insert immediately postoperative and 9 in the office the next day. In both groups, trace cell was present in all eyes at day 1 and had resolved in all but 1 eye in each group at days 7 and 30. Flare was absent in all eyes at every time point, and transient pain was reported in a single same-day eye on day 7. No insert-related adverse events were observed, and no eyes required rescue corticosteroid therapy or insert removal.Conclusion: Similar rates of inflammation and pain resolution after phacoemulsification were achieved with the dexamethasone intracanalicular insert placed either immediately postoperatively or the next day. These findings expand options for insert use to offer surgeons and patients greater flexibility in developing perioperative pain and inflammation control strategies.

Perioperative Management of Cleft Lip Repair: A Meta-Analysis and Clinical Practice Guideline

Objective: Few studies have focused on perioperative management of cleft lip repair. We sought to evaluate the available data on this topic to create evidence-based clinical guidelines. Design: Systematic review, meta-analysis. Methods: A PubMed search was performed focusing on perioperative management of cleft lip repair. Studies were included if they included comparative data. A systematic review and meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Main Outcome Measures: Systematic review of literature regarding wound closure, postoperative arm restraints, perioperative antibiotics, outpatient or ambulatory surgery, or feeding restrictions postoperatively. Results: Twenty-three articles met inclusion criteria after initial screening of 3103 articles. This included 8 articles on wound closure, 2 on postoperative restraints, one on perioperative antibiotics, 6 on outpatient surgery, and 6 on postoperative feeding. Meta-analysis could be performed on dehiscence rates with postoperative feeding regimen and readmission rates after outpatient versus inpatient lip repair. There were few studies with low risk of bias. Outpatient cleft lip repair does not increase readmission (odds ratio [OR]: 0.92, 95% CI: 0.28-3.07). Allowing postoperative breastfeeding or bottle-feeding does not increase dehiscence (OR: 0.61, 95% CI: 0.19-1.95). There was no evidence of publication bias. Conclusion: Within the limitations of available data, there is no evidence of a clearly superior closure material. The evidence does not support use of postoperative arm restraints. The evidence does not support the use of preoperative nasal swabs for antibiotic guidance. With careful patient selection, outpatient cleft lip repair appears safe. The evidence supports immediate breastfeeding or bottle-feeding after cleft lip repair.