PubMed · 8786858
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T O Sweet. 1996. DSSNY does well.. https://pubmed.ncbi.nlm.nih.gov/8786858/
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KEEP EXPLORING
The operative results and complications after stoma closure in 548 patients operated on between 1972 and 1993 are described in this retrospective study. The patients were divided into three groups (group I,n = 74, 1972-1976; group II,n = 256, 1977-1985; group III,n = 218, 1986-1993) according to the year of operation and changing concepts in colorectal surgery. The overall mortality rate was 2.0%. The morbidity rate including minor complications was significantly reduced from 70.3% in group I to 27.1% in group III. Postoperative wound infections and fever were the most common complications. The location of the stoma and the operative technique did not markedly influence the morbidity rate. The most striking decrease in complications was achieved by the combined usage of orthograde lavage and perioperative antibiotic treatment (14.6% wound infections, 6.9% postoperative fever). In conclusion, a standardized perioperative treatment protocol including orthograde lavage and antibiotics is recommended.
Patients undergoing 801 elective, clean-contaminated operations were assigned to one of the three following antibiotic regimens: 1) 1 g of cefazolin preoperatively, 2) 1 g of cefazolin preoperatively and another 1-g dose 3 hours later, and 3) 1 g of cefotetan preoperatively. These antibiotic regimens resulted in similar wound infection rates for procedures completed within 3 hours. When the procedure lasted more than 3 hours, the 6.1 per cent infection rate noted when a single dose of cefazolin was given proved significantly greater than the 1.3 per cent infection rates associated with the use of two doses of cefazolin or a single dose of the longer acting antibiotic, cefotetan (P < 0.01). Another series of 768 patients undergoing biliary and gastrointestinal tract operations were assigned to one of two antibiotic regimens: 1) a preoperative dose of 1 g of cefazolin and another 1-g dose 3 hours later if still in the operating room; 2) same as (1), plus 1-g doses every 8 hours for 24 hours. The longer period of antibiotic administration failed to improve the wound infection rate compared to the use of perioperative coverage only. These studies suggest that a single dose of preoperative antibiotic is sufficient for surgical prophylaxis when the operation is completed within 3 hours. Antibiotic coverage must extend for the duration of longer operations. A second dose of antibiotic or a single preoperative dose of an extended half-life antibiotic are equally effective. There is no value to administering antibiotics after the operation has been completed.
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