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PubMed1997

Prophylactic intravenous administration of caffeine and recovery after ambulatory surgical procedures.

OBJECTIVE: To determine whether prophylactic intravenous administration of caffeine, to daily caffeine users, decreases the frequency of postoperative headache and shortens recovery time. DESIGN: The study was a prospective, randomized, double-blind investigation with predetermined sample size and statistical power. MATERIAL AND METHODS: After Mayo Institutional Review Board approval and informed consent were obtained, 300 adult ambulatory surgical patients were enrolled in this study, which included randomization to receive either placebo or caffeine (200 mg intravenously) in the postanesthesia care unit. While recuperating, patients were allowed their choice of postoperative beverages. Before dismissal, patients completed a questionnaire providing details about intake of caffeine and tobacco, history of headache, and demographic data. Patients were considered "at risk" for symptoms of caffeine withdrawal if they did not drink a caffeinated beverage after the surgical procedure. RESULTS: Completed questionnaires were obtained from 234 patients. Patients at risk for symptoms of caffeine withdrawal were less likely to have a postoperative headache if they received caffeine intravenously rather than placebo-10% versus 23% (P < 0.05). Time until recovery was not significantly different between caffeine and placebo study groups. CONCLUSION: We conclude that prophylactic intravenous administration of caffeine was beneficial for those patients at risk for symptoms of caffeine withdrawal. For patients who consume caffeinated beverages on a daily basis, we recommend prophylactic administration of caffeine on the day of an ambulatory surgical procedure and anesthesia.

Adolescent↗
PubMed1990

[The Arabin cerclage pessary--an alternative to surgical cerclage].

During 1986-1988, the Arabin-cerclage pessary was used alternatively to surgical cerclage in 58 patients for prophylactic and in 44 cases of therapeutic indications. In 5 additional patients, the pessary was applied instead of emergency cerclage. The advantages of the cerclage pessary compared to other rigid pessary types, are based on its flexibility and adjustment to the anatomic conditions of vagina and cervix. The bowl-shaped pessary is inserted with the curvature upwards and the cervix is fixed in the central opening of the cerclage pessary. Thus a constriction, reconfiguration, and elongation of the incompetent cervix is obtained as evidenced by ultrasonography. The only side effect of the pessary treatment is an increase in cervical secretion and subsequent vaginal discharge. No infectious complications occurred. In 92% of the treated gravidae the cerclage pessary could be removed after the 36th week of gestation. Cerclage pessary can be recommended as a favourable alternative to surgical procedures as prophylactic or therapeutic approach, reducing surgical treatment significantly to less than 0.5%.

Cervix Uteri↗
PubMed1992

Which prophylactic regimen for which surgical procedure?

For optimal prevention of infection subsequent to a surgical intervention, it is necessary to follow a series of general principles, including the classification of the type of surgical intervention, the characteristics of the antibiotic used, and the route and the time of its administration. Moreover, with reference to the different types of surgery, other factors assume importance: the etiology of the infection and the ability of the antibiotic to achieve adequate levels in the tissues at the beginning of the infective process. In general abdominal, biliary, and obstetric-gynecologic surgery, which covers many clean-contaminated and contaminated interventions for which antibiotic prophylaxis has been shown to be the most effective, the etiology is often mixed (aerobic and anaerobic flora) with a predominance of gram-negative microorganisms. Thus, an appropriate prophylactic regimen must consider a third-generation cephalosporin, such as cefotaxime, that is effective against most gram-negative bacteria, in particular against Klebsiella pneumoniae. Acylureido penicillins can also be used because of their activity against enterococci, gram-positive microorganisms that are also causes of infection in this area of surgical intervention. Combining an antimicrobial such as clindamycin or metronidazole, which are particularly active against anaerobes, may be recommended as well. In urologic surgery, most infections are caused by Enterobacteriaceae; in addition to the antimicrobial spectrum, the ability of the antibiotic to concentrate adequately in the urine and renal tissue must also be considered. Beta-lactam antibiotics are the agents of choice, in particular, third-generation cephalosporins, aztreonam, and acylureido penicillins. In cardiac, orthopedic, and partially in neurologic surgery, where most infections are due to gram-positive bacteria (primarily methicillin-resistant staphylococci), antibiotic prophylaxis should include a glycopeptide agent (teicoplanin, vancomycin). In the field of surgical prophylaxis, more experience has been accumulated with cefotaxime, used as a short-course regimen or as a convenient single dose, than with any other newer cephalosporin. Cefotaxime's broad spectrum of action provides coverage against most potential pathogens and, when used as a single dose, is both convenient and cost-effective.

Anti-Bacterial Agents↗
PubMed1988

Infection rates in clean surgical procedures with and without prophylactic antibiotics.

One hundred calves with an uncomplicated umbilical hernia were included in a prospective study. The frequency of wound infection and recurrence of herniation were compared in animals operated on either with or without prophylactic antibiotics. In 90 calves operated on for the first time (60 without antibiotics and 30 with antibiotics) there were no infections and only one hernia recurred. In 10 calves operated on for the second time (seven without antibiotics and three with antibiotics) there were two infections and one hernia recurred in the group not receiving antibiotics.

Animals↗
PubMed1988

Infection rates in contaminated surgical procedures: a comparison of prophylactic treatment for one day or four days.

Eighty-three calves with a complicated umbilical hernia were included in a randomised prospective study. The frequency of wound infection was compared in two groups. The first group received antibiotics for one day, the second group for four days. The infection rate in calves receiving antibiotics for one day was 25 per cent compared with 8 per cent in calves treated for four days (P less than 0.05). Male calves were more susceptible to infection than female calves.

Ampicillin↗
PubMed1990

Predicting failure of low-dose prophylactic heparin in general surgical procedures.

Despite prophylaxis with low-dose heparin (LDH), postoperative thromboembolism (TE) still occurs in 10 per cent of patients undergoing abdominal operations. To identify predictors of TE in spite of LDH, 171 patients undergoing abdominal operations and receiving LDH were screened with the fibrinogen uptake test. Diagnosis of TE was confirmed in 24 (14 per cent; 95 per cent confidence limits of 9 to 20 per cent) by either venography or pulmonary scintigraphy, or both, or autopsy. As analyzed by multiple logistic regression, only age, body mass index, preoperative hemoglobin concentration and colorectal operations (yes or no) contributed to the prediction of failure of LDH, whereas sex, malignant lesion, previous TE, hypertension, diabetes mellitus and varicose veins did not. Based on the first 81 patients, an index was constructed that was able to identify 11 of 13 patients with TE and exclude 34 of 68 without TE. This index was then applied on a second series of 90 patients in whom it correctly identified ten of 11 patients with TE and excluded 40 of 79 patients without TE. It is concluded that, with the use of the index, it is possible to identify a group of patients undergoing elective abdominal operations in whom LDH is not sufficient prophylaxis. A practical approach to bedside prediction of failure of LDH prophylaxis by use of a simple score table is suggested.

Abdomen↗
PubMed1984

Prophylactic antibiotic usage in clean surgical procedures.

The article is a review of the results of a method of use of prophylactic antibiotic therapy in 2278 clean procedures performed by the author from 1959 to 1981. The procedures analyzed are mastectomy, cholecystectomy, inguinal hernia repair, incisional hernia repair, laparotomy, and thyroidectomy. These cases are considered separately and compared with other detailed series in the literature. The author feels that the infection rate of 0% in this series when compared to rates of 1.7 per cent to 5 per cent in the literature for the same type of cases warrants use of this method. The major points in the method are 1) use of topical irrigating solution of 0.5 per cent neomycin sulfate; 2) beginning proper intravenous antibiotic administration when the patient reaches the recovery room; 3) limit the use of antibiotic to 3 days past the day of surgery unless drains or hemovacs are still in place, in which case the antibiotic is continued for 24 hours after their removal; 4) careful and strict daily examination and evaluation of the patient in order to discontinue the antibiotic at the outset of any problems; 5) continued strict adherence to basic surgical principles throughout the entire surgical experience of the patient.

Anti-Bacterial Agents↗
PubMed1998

Antibiotic prophylaxis for surgical procedures: a survey from an Italian university hospital.

The aims of this study were: 1) to evaluate the surgical prophylaxis regimens adopted by surgeons of the University Hospital of the Faculty of Medicine and Surgery of the 2nd University of Naples during the period January-March 1996; 2) to compare uses of antibiotic prophylaxis carried out in surgical departments to standard international guidelines; 3) to assess the cost of surgical prophylaxis. Data from 1,085 surgical patients from January 1, 1996 to March 31, 1996, were collected, reporting surgical department, type of surgery, antibiotics used, dosage, and length of the prophylactic treatment. Collected data underwent computer-assisted evaluation and comparison to the international guidelines. Four-hundred and twenty-five patients with concomitant diseases, who did not meet inclusion criteria into standard guidelines, were excluded from the study. The remaining patients (N = 660) underwent clean or clean-contaminated surgical procedures. Two-hundred and twenty patients underwent clean surgical procedures, with prophylactic antibiotic treatment lasting from 1.1 +/- 0.3 to 4.6 +/- 2.8 days. Four-hundred and forty patients underwent a clean-contaminated surgical procedure, with antibiotic prophylaxis lasting from 3.6 +/- 2.4 to 5.2 +/- 3.7 days. Third generation cephalosporins were the most frequently used antibiotics both in patients undergoing clean (163 patients = 74.1%), and clean-contaminated surgical procedures (321 patients = 73%). The resulting costs were about ten-fold higher than costs of antibiotic prophylaxis carried out according to international guidelines. In conclusion, our research highlights the habit of non-compliance with standard guidelines for antibiotic prophylaxis both in terms of drug choice and treatment duration.

Antibiotic Prophylaxis↗
PubMed1984

Basic principles in the use of prophylactic antibiotics.

The prophylactic administration of antibiotic to the surgical patient is generally indicated whenever complicating infection of the incision or coelom to be violated is associated with a significant morbidity and/or mortality rate. For maximal benefit, antibiotic must be in the tissues at risk just prior to and throughout the entire period of bacterial contamination. When a parenteral route for delivery is uncertain, as in the case of shock or a burn wound, then topical application becomes a practical alternative. Only hospital surveillance, however, can dictate which patients and which surgical procedures warrant prophylactic antibiotic. Intelligently implemented, such a preventive programme can reduce significantly total expenditure for surgical health care.

Administration, Topical↗
PubMedDate not supplied

Postoperative wound infections in a children's hospital.

A prospective study was made of postoperative wound infections at Milwaukee Children's Hospital for 1 year. Essentially all procedures requiring a skin incision were included. The clean surgical wound infection rate was 3.1% (26 infections in 849 cases). There were no significant differences in clean wound infection rates among the individual surgeons or among the four busiest surgical services. The occurrence of postoperative wound infections was associated with administration of prophylactic antibiotics, longer duration of surgical procedures and longer hospital stay before and after surgery. About 50% of patients having a clean surgical procedure were given prophylactic antibiotics. Prophylactic antibiotic were given for 4 days or more in about half the cases.

Anti-Bacterial Agents↗
PubMed2005

Improving timely surgical antibiotic prophylaxis redosing administration using computerized record prompts.

BACKGROUND: Timely prophylactic antibiotic administration aids in preventing postoperative superficial surgical site infections. However, during lengthy surgical procedures, redosing of prophylactic antibiotics may be unintentionally omitted. We assessed the utility of a computerized reminder as part of the anesthesia charting system to increase the rate of timely intraoperative prophylactic antibiotic redosing. METHODS: A retrospective observational analysis was performed on consecutive patients undergoing non-cardiac surgical procedures at a university-affiliated hospital prior to and after the institution of a computerized reminder system. The reminder system presented the clinician with a series of on-screen dialog boxes prior to the redose time for the specific prophylactic antibiotic administered preoperatively. Antibiotic redosing was defined as appropriate if it occurred within 30 min prior to or after the due time, calculated as twice the half-life of the specific antibiotic. Patients were excluded if the case duration was less than twice the half-life of the administered prophylactic antibiotic, or if no prophylactic antibiotic was given. RESULTS: A total of 287 cases were included in the study (148 pre-intervention, 139 post-intervention). Patient age, case length, and American Society of Anesthesiologists (ASA) score stratification did not differ between the groups. Use of the reminder system resulted in an increase in the appropriate redosing of antibiotics from 20% prior to institution of the reminder to 58% after institution (p < 0.001). CONCLUSIONS: A computerized reminder system is an effective tool to assist in appropriate intraoperative redosing of prophylactic antibiotics during lengthy surgical procedures.

Adult↗
PubMed1988

Multidisciplinary program for promoting single prophylactic doses of cefazolin in obstetrical and gynecological surgical procedures.

A multidisciplinary cost-containment program for promoting the use of single prophylactic doses of cefazolin for obstetrical and gynecological surgical procedures is described. Following a one-month review of patient charts to identify the antimicrobial regimens used most frequently for prophylaxis in obstetrical and gynecological surgical procedures, the department of pharmacy services, with the cooperation of the pharmacy and therapeutics (P&T) committee and the departments of obstetrics and gynecology and infectious diseases, implemented an educational program to promote the use of single doses of cefazolin for surgical prophylaxis. The program included inservice education and distribution of letters of support and a therapeutics newsletter. Drug stocking patterns in the operating and delivery rooms were changed to make cefazolin more accessible, and the P&T committee formally restricted the use of prophylactic antimicrobial agents in obstetrical and gynecological surgical procedures to single doses of cefazolin unless a consulting infectious-disease physician recommended otherwise. Compliance with the program increased as each step was implemented; data collected 16 months after the program was initiated demonstrated a compliance rate of 78.8%. Based on comparison of data collected before initiation and six months after initiation of the program, an actual cost savings of +7,125 was realized, which extrapolates to +14,250 annually. No apparent adverse effects on patient care were noted. The multidisciplinary approach to promoting the use of single doses of cefazolin was effective.

Cefazolin↗
PubMed2000

Atlantoaxial immobilization in rheumatoid arthritis: a prophylactic procedure?

Timing of surgical intervention in atlantoaxial instability due to rheumatoid arthritis is still controversial. An aim of this study was to investigate whether atlantoaxial fusion can prevent progression of instability and upward migration of the dens. Thirty-two patients with rheumatoid arthritis, who underwent posterior atlantoaxial fixation due to instability, were clinically and radiologically examined after a minimum follow-up of 5 years. The radiological measurements focussed on the extent of cranial vertical migration after atlantoaxial fusion. In none of the 20 patients available for follow-up examination was a vertical cranial migration observed, in spite of the ongoing course of the disease. These findings are in concordance with findings in the literature, and strongly suggest that, with atlantoaxial stabilization, the inflammatory process with destruction of the lateral masses of the atlas is able to prevent further deterioration with vertical cranial migration.

Adult↗
PubMed1981

Perioperative heparin prophylaxis of deep venous thrombosis in patients with peripheral vascular disease.

Perioperative low dose heparin was administered to 24 patients who were compared with 19 control patients undergoing peripheral vascular surgical procedures. This prophylactic measure was ineffective in reducing the incidence of subclinical, postoperative deep venous thrombosis, as indicated by iodine-125 fibrinogen scanning. The data suggest that patients undergoing vascular surgery will not benefit from the routine application of this prophylactic regimen.

Fibrinogen↗
PubMed1990

Undetected diabetes and the plastic surgeon.

Plastic surgery candidates are generally healthy. Therefore, major postoperative complications are rare. Should they happen, the surgeon should search for possible causes, one of which is undetected diabetes mellitus. Six patients are presented who, based on the individual or family history or the unusual nature of their complications, were suspected of having diabetic tendencies. This experience necessitated our in-depth search into the role of silent or undetected diabetes. This report emphasizes the importance of positive family history of diabetes and the role of glucose tolerance tests on suspected cases. Even with normal glucose tolerance tests, however, some of these patients with a positive family history of diabetes and history of previous infections suffer from deficiencies in the chemotactic immune system. We recommend full discussion of the increased risk of infection and delayed healing with these patients, conservatism during surgical procedures, and prophylactic use of antibiotics perioperatively.

Aged↗
PubMed2025

Estimands for Clinical Effectiveness of Risk-Reducing Early Salpingectomy in Women With High Risk of Ovarian Cancer.

IMPORTANCE: Risk-reducing early-salpingectomy (RRES) and delayed oophorectomy (DO) is a novel 2-stage alternative prevention strategy to risk-reducing salpingo-oophorectomy (RRSO) that avoids detrimental consequences of premature menopause. However, direct data on the clinical effectiveness for ovarian cancer (OC) risk reduction are lacking. OBJECTIVE: To explore how to define clinical effectiveness from prospective cohort studies using the estimand framework and sample size requirements. DESIGN, SETTING, AND PARTICIPANTS: In this comparative effectiveness research study, estimand and analysis options were considered to evaluate the clinical effectiveness of RRES with DO by extending the UK PROTECTOR cohort study, a multicenter, prospective, observational, national cohort study (N&#x2009;=&#x2009;1250 recruited from January 1, 2019, to December 31, 2024) evaluating RRES and DO for OC surgical prevention. Participants were premenopausal women 30 years or older at increased OC risk due to BRCA1/BRCA2 pathogenic variants. Participants could choose RRES, RRSO, or no surgery at entry. Sample size requirements used initial data (eg, age and BRCA1/2 distribution) from PROTECTOR (analysis undertaken from January 1, 2024, to December 31, 2025). MAIN OUTCOMES AND MEASURES: Incidence of OC after (not at) RRES and before or at DO in women with normal histologic analysis findings at surgery. The proportion of cancers prevented was estimated as the completement of the observed (O) to expected (E; assuming no preventive effect of surgery) number of cancers detected (1&#x2009;-&#x2009;O/E). RESULTS: Initial data were obtained from 889 women in PROTECTOR (overall mean [SD] age, 39 [5] years), with 255 (28.7%) choosing RRSO (mean [SD] age, 42 [4] years), 405 (45.5%) choosing RRES (mean [SD] age, 38 [4] years), and 229 (25.7%) choosing no surgery (mean [SD], 38 [5] years). The preferred estimand outcome was OC incidence after surgery (RRES or RRSO) with a "while on intervention" strategy to account for intercurrent events. The primary target measure was the proportion of cancers prevented for RRES vs no surgery with superiority testing. The secondary target measure was noninferiority of RRES vs RRSO. An estimated 1150 RRES participants with 8 to 10 years of follow-up would provide approximately 92% power to show that 20% or more of cancers are prevented using a 1-sample binomial test of the O:E risk (external reference) at the 5% level under a range of assumptions and at least the same power for a noninferiority margin for the proportion of cancers prevented by RRES of those prevented by RRSO. Estimands based on incidence ratios had an infeasible sample size. CONCLUSIONS AND RELEVANCE: In this comparative effectiveness study of UK BRCA carriers, the estimand differed from other ongoing clinical effectiveness studies of RRES and DO. Advantages include direct use of expected risk at baseline (unknown at design stage), easier interpretation across cohorts than absolute risk differences, and providing a feasible recruitment target for PROTECTOR to evaluate clinical effectiveness.

Humans↗