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At least 271 records · Page 15Linked to original sources
PubMed2001

Do new surgeons have higher surgical-site infection rates?

We compared class I surgical-site infection (SSI) rates for new and experienced surgeons. Data showed that new surgeons in two surgical subspecialties associated with higher baseline SSI rates had rates higher than their experienced colleagues. They took longer in the operating room (OR), but did not operate on sicker patients. As the surgeons gained more experience (as measured by cumulative cases), their OR times and SSI rates decreased toward their colleagues'. New surgeons who perform infection-prone surgery may have higher SSI rates than more experienced colleagues until they gain experience. A new surgeon's SSI rate could be one factor considered in assessing competence.

Clinical Competence↗
PubMed1980

Treatment of bleeding esophageal varices by transabdominal esophageal transection with the EEA stapling instrument.

Six cirrhotic patients underwent emergency esophageal transection utilizing the EEA Auto Suture stapling instrument for treatment of unrelenting variceal hemorrhage. All were grade C, and the combination of ascites, encephalopathy, and jaundice was present in four. All were critically ill with ancillary medical problems, including recent subtotal gastrectomy with sepsis and dehiscence, coexisting malignant biliary obstruction, and respiratory insufficiency. All were anergic to skin testing. Four died in the postoperative period, primarily of problems related to sepsis and ascites present before operation. Autopsy showed a well-healed anastomosis without stricture and complete interruption of the varices in all. No patient had recurrent bleeding. All received oral or tube feedings after operation. Two survive at 2 and 1.5 years with no recurrence of varices. This is a rapid, simple, and effective technique which can be done with minimal blood loss or training. There is no diversion of portal blood and minimal interruption of collateral circulation. Whereas the long-term benefits in terms of rebleeding are not yet known, results to date suggest a trial earlier and in better risk patients as a definitive treatment procedure.

Aged↗
PubMed2005

An audit of pre-operative skin preparative methods.

INTRODUCTION: A study into how pre-operative skin preparation varies between surgical units and surgeons. MATERIALS AND METHODS: A postal audit of general, vascular and thoracic surgeons in Northern Ireland was conducted together with a literature review to establish best practice. RESULTS: Overall, 73 surgeons were contacted, and 63 (86.3%) responded. There was marked variation in shaving of the operative site. A wide range of solutions was used, and 14 different sequences were employed. All surgeons used a swab or sponge to apply the solutions. Several drying methods were employed. CONCLUSIONS: There is variation in the method of skin preparation employed between surgical units and surgeons. There is limited evidence-based research on this topic. Recommendations are made as to best practice.

Anti-Infective Agents, Local↗
PubMed1976

Fundoplication for reflux esophagitis: misadventures with the operation of choice.

Fundoplication, whether performed by thoracic or abdominal approach, is a sound method for control of reflux esophagitis. A series of 312 operations have been reviewed to assess the frequency of complications and the methods by which these can be prevented or treated effectively. Each source of an untoward outcome is examined in detail, and suggestions as to prevention or recognition are advanced. The current low death and complication rates have been lowered even more by a conscious effort to refine the procedure further; such efforts have been associated with a failure rate of less than 5% in a mean followup of 4 years.

Deglutition Disorders↗
PubMed2006

[Responsibility of surgeons for surgical site infections].

Surgical site infections can be traced to discrepancies in one specific hospital department: the operating suite. Therefore, prevention is often viewed as resting completely on the surgeon. However, the source of micro-organisms responsible for surgical site infections can be endogenous or exogenous. Most infections are believed to be the former, i.e. caused by micro-organisms already resident in the patient's body. Therefore the surgeon can be regarded as suspect only in exceptional cases and usually himself a victim. Prevention is possible not only for exogenous surgical site infection but also many endogenous infections. A multicenter surveillance of infection rates at 130 operative departments participating for at least 4 years in the German National Nosocomial Infection Surveillance System was conducted. A significant 25% reduction in the 3rd year was observed compared with patients who underwent surgery within the 1st year of participation. However, surgeons alone cannot achieve such a decrease, and a team approach is required under most circumstances.

Adult↗
PubMed1980

Use of prophylactic antibiotics in surgery.

A prospective survey of 352 surgical patients revealed that 52% (183 patients) were given antibiotic drugs perioperatively, (32% (111 patients) for prophylaxis and 20% (72 patients) for treatment of established infection). Prophylaxis was not reasonably indicated in only 24 patients, but there was little standardization of drug, dose, timing or duration of courses. The mean duration of prophylactic courses was six days; less than half began before operation. Thirty-two patients (11% of 283) developed an infection after operation; the incidence in patients with and without antibiotic prophylaxis was 17% (19/111) and 8% (13/172) respectively, but the former were, in general, higher risk subjects. Antibiotic use determines the emergence of resistant microorganisms and efficacy of prophylaxis is in the main unproven. Clearly, a carefully considered policy on antibiotic prophylaxis within an institution is a logical necessity yet to be realized.

Anti-Bacterial Agents↗
PubMed1977

Prophylactic antimicrobial drug therapy at five London teaching hospitals. A report by the Study Group on the Use of Antimicrobial Drugs.

We report some findings of a survey of antimicrobial prophylaxis in 5 London teaching hospitals. It is practised predominantly in surgical patients, both before and after operations, penicillins being by far the commonest drugs. Striking differences were found, particularly in the duration of treatment in different hospitals in the same specialty, and also between consultants in the same hospital. The findings raise important questions that need to be answered by clinical trials.

Administration, Oral↗
PubMed2000

[Iatrogenic vascular injuries demand a lot from the surgeon. Better to prevent--errors and lack of knowledge can have serious consequences for the patient].

To investigate causes and consequences of iatrogenic vascular injuries requiring surgical repair, we retrospectively reviewed 18 cases during a ten year period between 1989 and 1999 at Karolinska sjukhuset. We hoped to identify specific injury patterns in these cases, which were found in all operating specialties. Inattention to vascular structures was the single most common cause of iatrogenic vascular injury. The second most common context was radical operations of cancers in which the tumor was adjacent to the vessel. A third cause was misunderstanding of the specific anatomy of the area. This study demonstrates that serious iatrogenic vascular injuries pose a great challenge for the surgeon. Representing a significantly increased risk for the patient, these serious incidents should be preventable through modifications in surgical technique.

Adult↗
PubMedDate not supplied

Maintenance of skeletal muscle intracellular glutamine during standard surgical trauma.

Skeletal muscle glutamine (GLN) concentration falls following injury and infection. In an attempt to prevent this decline and to characterize its influence on the efflux of amino acid (AA) from skeletal muscle, we administered varying quantities of AA (0,2, and 4 g/kg X day) as saline or AA solutions with or without GLN enrichment to 22 postoperative dogs. Plasma and muscle AA were determined before and 24 hr after standard laparotomy. Hindquarter AA efflux was measured at 6 and 24 hr. Skeletal muscle nitrogen declined in saline controls (69.8 +/- 8.5 vs 52.8 +/- 8.4 mmol/liter; p less than 0.01), largely due to the fall in intracellular GLN (21.48 +/- 3.21 vs 15.86 +/- 3.80; p less than 0.05). Similar alterations were seen in the animals receiving 2 g/kg. However, both intracellular nitrogen and GLN were maintained in animals receiving 4 g/kg, whether the AA solutions contained GLN or not (skeletal muscle nitrogen before 64.3 +/- 8.6 mmol/l vs 65.4 +/- 7.0 after, GLN 19.2 +/- 3.4 vs 19.9 +/- 3.0). Hindquarter AA efflux was reduced in those animals at 6 hr compared with saline-treated animals (-6.52 +/- 1.8 and -7.70 +/- 5.90 vs -19.05 +/- 4.06 mumol/kg X min; p less than 0.05). Intracellular GLN can be maintained during operative stress with adequate nitrogen infusion. Replacing 50% of the balanced AA solution with GLN resulted in equally effective maintenance of intracellular GLN levels and a comparable reduction in skeletal muscle AA efflux. Preservation of normal intracellular GLN levels with adequate AA nutrition may be essential for the conservation of muscle protein.

Amino Acids↗
PubMed1997

[Practical and theoretical aspects of cost-benefit relations in viscerosynthesis].

The necessity of limiting health care costs requires adequate service recording and quality control even in visceral surgery. In this field, the safety of the anastomoses is of greatest importance. Anastomoses at risk are esophageal connections to jejunum or colon and deep rectal anastomoses. At these locations expensive suture devices, such as stapling instruments, can be used in a cost saving aspect, if they help to increase anastomotic safety, time saving and expansion of surgical indication. Manual sutures thus represent the cheapest anastomotic technique as continuous sutures would cost between DM 10.- to 20.- and single stitch sutures between DM 60.- and 100.-. A surgical school should prevalently aim at training manual anastomoses, while special anastomotic techniques should only complete the skill for selected indications. The overall staff expenditure for extended operations amounts around DM 600.- per hour respectively DM 10.- per minute. Time for surgery might be shortened by auxiliary tools as much as to perform an additional operation. However, a circular stapler anastomosis that costs between DM 650.- to 850.- is twice as expensive as manual sutures notwithstanding the double time needed. In the past years, the necessity for a rational use of different anastomotic techniques has shown to be mandatory since, increasingly, financial aspects of health economy require cost benefit calculations in visceral surgery.

Abdomen↗
PubMed1989

Surgical wound infections.

At the last meeting of the SURGIKOS Operating Room/Infection Control Combined Advisory Panel, guest speakers reviewed current thinking and practices that have an impact on surgical wound infections. Presentation topics included the role of the CDC, nursing and classification systems in controlling wound infections; cost effective epidemiologic methods of reducing infections; and outcomes of surgical wound infection prevention practices deemed critical by the Joint Commission on Accreditation of Healthcare Organizations. The following is a brief overview of the presentations that guided panel discussions on these topics.

Antisepsis↗
PubMed2001

Quality of life and functional level in elderly patients surviving surgical intensive care.

BACKGROUND: The elderly consume up to one third of health care resources and have become a target for cost reduction efforts. This study was performed to evaluate elderly survivors of surgical critical illness using perceived quality of life and activities of daily living as indicators of value of care. STUDY DESIGN: Six hundred seventy-two patients age 70 years and older admitted to a surgical intensive care unit between October 1, 1992 and March 31, 1995 were studied. Intensive care unit and hospital length of stay, admission type and service, and severity of illness were integrated with preadmission and current activities of daily living in survivors. Perceived quality of life was assessed where obtainable from patient or direct proxy. RESULTS: Activities of daily living were obtained on 342 (50.9%) and perceived quality of life evaluations on 240 (35.7%) of the initial study population. Median duration from admission to evaluation was 21 months. Activities of daily living scores decreased significantly overall from 4.75+/-0.72 (mean; +/- standard deviation) to 4.22+/-1.41, the proportion of completely independent patients fell from 84.9% to 72.0%, and the number of completely dependent patients rose from 0% to 3.8%. Perceived quality of life scores were not significantly different than scores in healthy patients living in the community. Using regression models, age, service, APACHE II score, and emergent operation or admission did not demonstrate relationships to changes in activities of daily living scores. CONCLUSIONS: Although overall functional levels fell, rates of full dependency rose only slightly and perceived quality of life was high in a group of elderly patients surviving surgical intensive care. High hospital and postdischarge mortality should not motivate restriction of care for elderly patients requiring surgical intensive care given their high postillness subjective quality of life measures.

APACHE↗
PubMed1993

Arthroscopic shoulder capsulorrhaphy using metal staples.

Staple capsulorrhaphy on the shoulder using a metal staple for traumatic anterior instability has the advantages of increased diagnostic accuracy, microdebridement of the pathology, accurate assessment of the glenohumeral ligament pathology, and selective repair of the ligament pathology. Although the same advantages should apply to staple capsulorrhaphy for traumatic posterior instability, our experience remains very limited. Staple capsulorrhaphy on the shoulder has multiple disadvantages, including being technically difficult with a slow learning curve, not being applicable to all unstable shoulders, an average failure rate of 12% that may be related to inadequate postoperative immobilization, no extra-articular reinforcement, and the use of a metal implant that may need to be removed at a second operation. Staple capsulorrhaphy is currently performed for traumatic anterior instability in the shoulder, with a selected repair of the pathology using a single, well-placed staple and prolonged postoperative immobilization. The design of the staple affords a simpler insertion technique than rivets, screws, and intra-articular sutures. The advent of a biodegradable staple should eliminate inherent problems of metal implants while preserving the advantages of this method.

Adolescent↗
PubMed1998

[The comprehensive prevention of suppurative wound infection in the postoperative period in diabetic patients].

The strict acceptance of the radicalism principles while the purulent inflammation origin eliminate, an accurate sanation and early placement of suture on the operation wound, its adequate and active drainage in combination with expedient local with the help of foamy aerosol "Dioxizol" and stable compensation of hyperglycemia, correction of the homeostasis disorders are necessary in the treatment of diabetes mellitus patients with local purulent-necrotic disease of the soft tissues.

Aerosols↗