Erratum: Factors influencing patient falls in a private hospital group in the Cape Metropole of the Western Cape

No abstract available.

P012 RISK FACTORS FOR INCISIONAL HERNIA AND ITS RECURRENCE: OBSERVATIONAL, AMBISPECTIVE STUDY

Aims In patients with herniorrhaphy treated in a 3rd level hospital in the Southwestern of Colombia from January 2014 to March 2020, determine the frequency of incisional hernia recurrence and the risk factors related to. Materials and methods Observational, ambispective study that included patients older than 15 years with a history of incisional hernia that agreed to participate and signed a consent form. Patients with incomplete data or who underwent surgery in another institution were excluded. Follow-up appointments every 3 months were made to evaluate the incidence of hernia recurrence. Results 112 patients were included, 64.3% female with a mean age of 58.6-year-old. The frequency of recurrence was 38.4% with a mean of appearance of 22.9 months; 44.2% were repaired with only one technique and 39.5% with non-mesh. Non-use of mesh increased the risk for recurrence (RR 2.02; CI95%: 1.17-3.48). Other risk factors were urgent surgery (RR 1.82; CI95%: 1.14-2.91), defect closure with multifilament suture (RR 1.61; CI95%: 1.15-2.25), not do adhesiolysis (RR 3.17; CI 95%; 0.85 – 11.76) and the no use of postoperative antibiotics (RR 1.67M CI95%: 0.97-2.89). Conclusions Incisional hernia recurrences increase with time. Therefore, a follow-up of at least for 3 years should be guaranteed to avoid undiagnosed cases. Risk factors identified like absorbable multifilament sutures and non-use of the mesh must be removed from the surgery plans. Furthermore, a specialized in-hospital group of the abdominal wall and an institutional protocol would help to diminish this complication.

Prof. Dr. Michel Zerah

Michel Zerah was born on May 22, 1956 in Paris, France. He finished his medical study in 1985 at Faculté de médecine de CRETEIL (Paris, France) and graduated in Neurosurgery in April, 1988. Quickly took over as head of Clinic-Assistant of Paris Hospitals, “Service de Neurochirurgie de l’hôpital de Bicêtre” (1989) and as university professor (1998) at “Service de Neurochirurgie pédiatrique” of hospital group “Necker-Enfants Malades”. Prof. Zerah was a great teacher and mentor to countless neurosurgeons, around the world and here in Brazil. He participated in several courses and congresses, highlighting his unconditional dedication to teaching. With his knowledge, his humility and incredible charisma he made countless friends and students wherever he went. His lectures have always been unique experiences, approaching each subject in a masterly way, with emphasis on craniocervical transition diseases and spinal dysraphimos. He has authored more than 261 scientific articles and several books and book chapters, with emphasis on lumbar lipomas surgery, Chiari, deposit diseases, among others. His last project was the development of fetal surgery at Necker Hospital. Michel Zerah had an incredible ability to bring people together and, thus, he walked a path of respect, affection and friendship wherever he went. He was head of the Pediatric Neurosurgery Service at Hospital Necker, Paris, France where he devoted a large part of his life, teaching and operating numerous children. An immense and irreparable loss for everyone who knew him and who had the privilege of working and living with him. Short Biography: Head of the Pediatric Neurosurgery Service – Hospital Necker, Paris, France President of the European Society for Pediatric Neurosurgery (ESPN) President of the French Society of Pediatric Neurosurgery Member of the French National Academy of Surgery PhD in Mathematics, Statistics and Computer Science Coordinator of the European Course on Pediatric Neurosurgery between 2002 and 2014. Collaboration with the Society of Neurosurgery of Vietnam where he practiced solidarity work and trained numerous professionals. 324 communications or conferences in National or International Meetings 32 Chapters in Books 123 articles in Scientific Journal

Management of intertrochanteric femoral fractures at Level 1 trauma center in Leningrad Region

Relevance. An in-house Protocol for proximal femoral fracture management was developed at Vsevolozhsk Clinical Interdistrict Hospital of Leningrad Region.Intention To demonstrate possible practical application of preliminary federal clinical guidelines at Level 1 trauma center in Leningrad Region including comparative analysis of its efficacy when treating intertrochanteric femoral fractures.Methodology. Post-surgery outcomes were retrospectively assessed in 86 patients of Vsevolozhsk Clinical Interdistrict Hospital (Group 1, per Protocol) and 28 patients of Tosno Clinical Interdistrict Hospital (Group 2, w/o Protocol) with intertrochanteric femoral fractures (31A by Arbeitsgemeinschaft für Osteosynthesefragen classification and S72.1 by ICD-10).Results and Discussion. There were no significant differences in patients’ age, methods of anesthesia and osteosynthesis between the groups. Group 1 demonstrated statistically significant decrease in preoperative bed-days, time to sitting up in bed after surgery, ambulation with walkers and duration of hospitalization. Group 1 patients needed less assistance from other health-care professionals, less intensive therapy and blood transfusions.Conclusion. Adoption of in-house protocols, optimization of supply and staffing as well as involvement of multidisciplinary teams will improve management of proximal femoral fractures.

THE PAYMENT FOR AN ORGAN AND THE ADMISSION OF GUILT BY A SOUTH AFRICAN HOSPITAL The State v Netcare Kwa-Zulu Natal (Pty) Ltd – Agreement in terms of section 105A(1) of the Criminal Procedure Act 51 of 1977, Netcare Kwa-Zulu (Pty) Ltd and the State, Commer

As the first of its kind in plea bargaining, a South African private hospital group pleaded guilty on charges of trafficking in human organs. The Commercial Crimes Court of the Kwa-Zulu Regional Court (a Specialised Unit of the National Prosecuting Authority of South Africa) made an order in November 2010 in terms of which Netcare Kwa-Zulu (Pty) Ltd (Netcare) entered into a plea and sentence agreement with the state whereby Netcare pleaded guilty to 109 counts related to charges of illegal kidney transplantoperations. Charged with the St Augustine’s Private Hospital in Durban were the parent company Netcare (Pty) Ltd, its Chief Executive Officer, Richard Friedland, and eight others: four transplant doctors, a nephrologist, two transplant administrative co-ordinators, and a translator. The admission of guilt by the group relates to illegal kidney transplants which took place between June 2001 and November 2003 whereby Israeli patients in need of kidney transplants were brought to South Africa for such transplants to be performed at St Augustine’s Private Hospital. The kidneys were bought from Romanian and Brazilian citizens who were willing to sell their organs.

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

Comparison of Surgical Outcomes for Finsterer and the Roux-en-Y Reconstruction after Distal Gastrectomy for Gastric Carcinoma

Objective. There have been surgical procedures to reconstruct the gastrointestinal continuity after distal gastrectomy. This study is aimed at comparing the surgical outcomes of reconstructing gastrointestinal continuity by the method of Finsterer and Roux-en-Y after distal gastrectomy due to cancer. Materials and methods. 86 patients, who underwent distal gastrectomy due to cancer, were divided into 2 groups for reconstructing gastrointestinal continuity from March 2014 to August 2018 at Viet Duc Hospital: group 1 (44 patients) by the Finsterer method and group 2 (42 patients) by the Roux-en-Y method. Results. The concentrations of bilirubin and amylase in gastric liquid after first flatus were 97.6 mmol/l and 20016 mmol/l for group 1 and 0.5 mmol/l and 152 mmol/l for group 2 ( p = 0.01 ), respectively. The rate of reflux with clinical manifestations was 45.7% for group 1 and 9.4% for group 2 ( p = 0.001 ). The average operation time was 155.7 ± 25.9 (90-200) minutes for group 1 and 170.3 ± 22.3 (120-215) minutes for group 2 ( p = 0.007 ). The number of lymph nodes was 19.1 ± 4.8 (13-37) for group 1 and 20.3 ± 4.5 (12– 33) for group 2 ( p = 0.243 ). There was 1 case of mesenteric bleeding in group 2 (2.4%). The dumping syndrome occurred in group 1 (20%) and group 2 (9.4%) ( p = 0.31 ). Conclusion. The Finsterer and Roux-en-Y methods proved to be equally effective in their feasibility and safety. However, the Roux-en-Y method was better than the Finsterer method at limiting bile reflux and gastritis.

Real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China: Evidence from the ACURE study

Background: The evidence for real-world antibiotic use in treating acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is insufficient. This study aimed to investigate real-world antibiotic use in the management of AECOPD in China.Methods: All hospitalized AECOPD patients from the acute exacerbation of chronic obstructive pulmonary disease inpatient registry (ACURE) study conducted at 163 sites between January 2018 and December 2019 were screened according to the eligible criteria. The eligible study population was divided into secondary and tertiary hospital groups. Patients’ baseline characteristics, antibiotic use, and bacterial pathogen characteristics were retrieved and analyzed using SPSS 23.0.Results: A total of 1663 patients were included in the study, including 194 patients from secondary hospitals and 1469 patients from tertiary hospitals. Among the 1663 AECOPD patients enrolled, 1434 (86.2%) received antibiotic treatment, comprising approximately 85.6% and 86.3% of patients in the secondary and tertiary hospital groups, respectively. The median antibiotic therapy duration was 9.0 (interquartile range [IQR]: 7.0 - 11.0)°days. Regarding the routes of antibiotic use, 1400 (97.6%) patients received intravenous antibiotics, 18 (1.3%) patients received oral antibiotics, 15 (1.0%) patients received both intravenous and oral antibiotics, and one (0.1%) patient received both oral and nebulized antibiotic treatment. In addition, cephalosporin, penicillin, and quinolone were the most commonly prescribed antibiotics (43.6%, 37.0%, and 34.2%, respectively). In total, 990 (56.5%) patients underwent pathogen examinations; the proportion of patients receiving pathogen examinations in the second hospital group was significantly lower than that in the tertiary hospital group (46.4% vs 61.3%, p < 0.001).Conclusion: This study demonstrates that an antibiotic overuse may exist in the treatment of AECOPD in China. Measures should be taken to prevent the overuse of antibiotics and potential antimicrobial resistance (AMR) in Chinese AECOPD patients.