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PubMed1985

A prospective study of postoperative fever in a general surgery department.

During a 4-month period, 693 patients undergoing surgical procedures were prospectively studied to investigate the etiology of postoperative fever (greater than or equal to 38 degrees C during 48 hours or more). The overall rate of fever was similar for the three categories of surgical procedures studied (14%, 13.4% and 13.1% respectively after clean, clean contaminated and contaminated surgical procedures). No cause of fever was found in 5%, 2.7% and 1.7% of patients who underwent clean, clean contaminated and contaminated surgical procedures. Several episodes of fever were observed for 12 patients after clean surgery; for 11 of them this was due to infection. The mean interval between febrile episodes was 4.7 days. After clean wound surgery, fever documented as infectious began significantly later (2.7 vs 1.6 days) and lasted significantly longer (5.4 vs 3.5 days) than fever for which no source was determined. Only half of the infections were associated with fever.

Cross Infection↗
PubMed2004

Surgical site infection of 7301 traumatologic inpatients (divided in two sub-cohorts, study and validation): modifiable determinants and potential benefit.

The widespread use of peri-surgical chemoprophylaxis is decreasing the incidence of surgical site infection in Traumatology, which nevertheless remains as a problem amenable to further reduction. We have tried to identify modifiable determinants of the avoidable incidence of surgical site infection, and to estimate the potential benefit from implementing adequate measures targeting those determinants. In a firts sub-cohort of 5320 traumatologic patients with a post-surgical stay of more than 2 days, in Madrid's La Paz Hospital, between 1991 and 1996. The epidemiological surveillance was prospective during their hospital stay but also includes data on readmissions due to infection so as to analyse the actual incidence of surgical site infection, both before and after discharge. Bivariate and multivariate (multiple logistic regression model) analyses of risk factors for surgical site infections have been performed. In this sub-cohort, 212 patients (3.9%) suffered some type of nosocomial infection. The incidence of surgical site infection before discharge in cases of clean surgery was 1.6%, rising to 2% when cases readmitted for infection after discharge were considered. The multivariate analysis of risk factors for surgical site infection identified the following: contaminated ('dirty') surgery (OR: 10.5), inadequate chemoprophylaxis (OR: 1.5) and a pre-surgical stay of more than 4 days (OR: 1.6). Next, a second sub-cohort, consisting of 1981 patients, treated between 1997 and 1999, was analysed to validate the results of the first multivariate analysis. The validation model (and the global cohort with 7301 patients) corroborates the importance of the same three factors. Last, we calculated that controlling two modifiable factors, pre-surgical stay and peri-surgical chemoprophylaxis, could avoid 56% of surgical site infections.

Adult↗
PubMed1999

Perioperative transcutaneous pacemaker in patients with chronic bifascicular block or left bundle branch block and additional first-degree atrioventricular block.

BACKGROUND: Complete heart block is dreaded perioperatively in patients with chronic bifascicular or left bundle branch block (LBBB) and additional first-degree A-V block. Our aim was to investigate the necessity as well as the efficacy and safety of transcutaneous pacing in the perioperative setting. METHODS: Thirty-nine consecutive patients with asymptomatic chronic bifascicular block or LBBB and prolongation of the P-R interval scheduled to undergo surgery under anesthesia were prospectively enrolled in the study. Preoperatively, a transcutaneous pacemaker (PACE 500 D, Osypka Co.) was applied; its efficacy was checked with intra-arterial blood pressure measurement; the pain level was recorded. Additionally, 24-h Holter monitoring (CM2, CM5) was applied. Occurrences of a block progression or a bradycardia of <40 beats/min with hemodynamic impairment were the defined end points. RESULTS: Thirty-seven of the 39 patients (95%) could be successfully stimulated with a median current strength of 70 mA; whereby 33 of the 39 patients felt moderate to severe pain. There was no perioperative block progression. Three cases of brady-cardia of <40 beats/min with a critical drop in blood pressure occurred; but these patients were successfully treated with drug therapy without pacemaker stimulation. CONCLUSION: The perioperative application and testing of the pacemaker was safe and could be performed in nearly all patients successfully. However, we do not consider a routine prophylactic transcutaneous placement in patients with chronic bifascicular or LBBB and additional first-degree A-V block justified. Nevertheless, appropriate drugs and temporary pacemaker equipment should be easily accessible.

Aged↗
PubMed1962

Surgical stapling.

Explore the source record for details and available documents.

Equipment and Supplies↗
PubMed1999

Surgical wound infection surveillance: the importance of infections that develop after hospital discharge.

BACKGROUND: The aim of this study was to evaluate two methods of post-discharge surgical wound surveillance and to compare the incidence and outcomes of wound infections that develop prior to patients' discharge with those that develop after hospital discharge. METHODS: One thousand, three hundred and sixty inpatients who underwent major elective surgery in an 800-bed teaching hospital in western Sydney between February 1996 and July 1997 were followed prospectively. Pre-discharge wound surveillance was performed by clinical assessment by an independent researcher on the fifth (or later) postoperative day. Post-discharge wound surveillance was performed by a mail out of questionnaires completed independently by patients and surgeons. RESULTS: Overall, 138 wound infections were diagnosed (incidence 10.1%), of which fewer than one-third (n = 44) were diagnosed before discharge (average 10.4 days postoperatively) and the remainder (n = 94) after discharge (average 20.6 days postoperatively). Seven hundred and eighty-two (57.5%) post-discharge survey forms were returned by patients and 680 (50.0%) by surgeons. When forms were returned by both surgeons and patients for the same wound (641 cases), there was substantial agreement in diagnosing infection or no infection (kappa = 0.73). CONCLUSIONS: The majority of nosocomial surgical wound infections develop after the patients' discharge from hospital. A post-discharge surveillance programme including self-reporting of infections by patients and return of questionnaires by patients and surgeons is feasible in an Australian hospital setting. However, such a programme is labour and resource intensive and strategies to increase return of questionnaires are required.

Antibiotic Prophylaxis↗
PubMed2000

Using clinical indicators to identify areas for quality improvement.

Clinical indicators (CI) are increasingly being used to assess the quality of health care being provided by physicians and hospitals. However, a standardised reporting format and a methodology to assess the utility of the CI data has not been developed. This paper provides the reporting format that has been developed for the clinical colleges. The results for four surgical indicators are used to illustrate how the CI data can determine the potential to improve the quality of care. Numerical estimates of the potential gains that could be made are calculated by: (i) determining the outcome if the current mean rate was shifted to the rate for the best 20% of hospitals and (ii) identifying units with unusual variation in rates and shifting their rate to the average. All four indicators reveal gains that could impact on health policy and clinical practice.

Arthroplasty, Replacement, Hip↗
PubMed2001

Protocol implementation in hospital infection control practice: an Italian experience of preoperative antibiotic prophylaxis.

This study evaluates the effectiveness of a protocol implemented to induce behavioural modifications in healthcare workers (HCWs). A preoperative antibiotic prophylaxis protocol for surgical procedures in clean and clean-contaminated wounds was used. The study was conducted in a 300-bed Italian university hospital between 1998 and 1999. The protocol's impact was analysed by retrospective examination of the clinical records for selected common surgical procedures. The study also investigated the reasons for the low compliance with the protocol through a focus group methodology. We examined 723 surgical procedures and the overall compliance was 30.8% (56/182) before the implementation of the protocol and 45.2% (76/168) after 1 year (P< or = 0.01). During the same period compliance with the use of antibiotics increased when antibiotics were recommended by the protocol (5/115 vs. 19/109, P< or = 0.01) and use decreased when they were not (51/67 vs. 57/59, P< or = 0.01). As reported in the focus groups, reasons for low compliance included hospital policy weaknesses in protocol definition and implementation and the cultural behaviour of HCWs. Our results reinforce previous findings that monitoring the effectiveness of protocol implementation in the medical care setting is essential. Critical points that might increase the effectiveness of protocol implementation have also been identified.

Anti-Bacterial Agents↗
PubMed2001

Evaluation of current practices in surgical antimicrobial prophylaxis before and after implementation of local guidelines.

The aim of antibiotic prophylaxis (ABP) is to prevent or at least decrease the incidence of postoperative surgical wound infections. In 1992 and 1995, ABP was the subject of two French consensus conferences. Following these conferences, the local Antibiotics Committee of Hopital Saint-Louis has undertaken a study to evaluate and eventually improve the current practices of ABP. This study was carried out in three steps: a first survey of ABP, the writing of local ABP guidelines and a second survey of ABP after the implementation of these recommendations. Concerning all surgical wards, the first survey found 69% (N = 100/145) of ABP practice is to be inappropriate vs. 18% (N = 25/139) in the second survey. Indications, choice of drugs, selection of dosage, administration timing and treatment duration were significantly improved in the second survey. Writing and implementing local recommendations promoted a more rational use of ABP. In addition, this study allowed Saint-Louis Hospital to set up recommendations for plastic surgery; such recommendations are poorly described in the literature.

Adolescent↗
PubMed2002

A prospective comparison of antibiotic usage in pediatric surgical patients: the safety, advantage, and effectiveness of the Surgical Infection Society guidelines versus a common practice.

BACKGROUND: The Surgical Infection Society (SIS) guidelines for antibiotic (Ab) usage minimally changed the surgical practice. The authors believed that clinical evidence of the safety, advantage, and effectiveness of SIS guidelines may improve inappropriate usage of Ab. METHODS: A group of dedicated surgeons attempted to use Ab appropriately to SIS guidelines in their patients (group A). A comparison was made with a concurrent cohort of patients (group B), treated by surgeons who were nonsupporters of SIS guidelines. The trial was conducted in 378 children between March 1999 and May 2000. The outcome measures were morbidity and mortality rates, Ab treatment duration, timing of administration, unjustified spectrum, and switch of Ab. Analysis of variance and Chi2 test were used in statistics. P value less than.05 was considered significant (s). RESULTS: Group A included 124 patients and Group B, 254. There were no intergroup differences in age, sex, and clean/contaminated/dirty ratio of procedures. The mean duration of Ab treatment was 3.9 days in group A, versus 7.1 days in group B (s), with overall rate of appropriateness of 77% versus 36% (s) and no differences in mortality and morbidity rates. CONCLUSION: Perhaps these results may change Ab usage in pediatric surgery.

Adolescent↗
PubMed2000

Analysis of 158 frontal sinus fractures: current surgical management and complications.

A retrospective analysis is presented of 158 patients who sustained frontal sinus fractures and were subsequently treated in the Division of Maxillofacial Surgery, University of Turin, from 1987 to 1998. The fractures were subdivided according to involvement of anterior and posterior walls, and of the nasofrontal duct. While treatment involving only the anterior wall is well standardized and without complications, management of anterior plus posterior wall fractures or involving the nasofrontal duct is still controversial. In dislocated posterior wall fractures, cranialization and obliteration of the remaining dead space and of the nasofrontal ducts using bone grafts, combined with the use of a pericranium flap, allow separation of the nasal cavity from the anterior cranial fossa, preventing ascending infections and thus reducing the rate of complications. When the fracture involves the nasofrontal duct with the posterior wall substantially intact, it is better to re-establish patency of the nasofrontal duct with a drainage tube and preserve the function of the sinus. A protocol used in the management of each group of fractures, clinical and radiological results, timing of operation, surgical procedures, outcomes, and long-term complications are all discussed.

Adolescent↗
PubMed2006

[6 years V.A.C. in general surgery -- clinical data from 128 patients].

Since the introduction of vacuum assisted closure therapy (V.A.C.) at the Department of Surgery/St. Anna-Hospital Herne has taken place in 2000 there was a rapid increase of indications to use this therapy. We present data from 128 patients who were treated with this method from 2000-2005 for different kinds of diseases. We report the management of a 78-year-old male patient who developed a Fournier's gangrene after an acute appendicitis with retroperitoneal perforation and an enterocutaneous fistula of the cecum. Using V.A.C. in surgery, a quick and safe treatment of infection and healing could be achieved.

Aged↗
PubMed1987

In vivo registration of Achilles tendon forces in man. I. Methodological development.

Mechanical behavior of muscle and its control is largely unknown under normal movement conditions. The present report deals with the methodological development to record directly in vivo forces from the human achilles tendon (AT) when the subjects perform normal movements ranging from slow walking to maximal sprinting and jumping. The development began with animal experiments, which dealt with the transducer design, surgical operation procedures, and duration of implantation. The first human experiment utilized an E form transducer implanted around the AT under local anesthesia. The transducer was kept in situ for 7 days, and on the 8th day recordings were made on simple plantar flexion movements and during slow walking. Further development led to final selection of a "buckle"-type transducer, and the measurements can be made immediately after operation and they usually last 2-3 h. The AT transducer can be calibrated by placing the subject in a prone position on to a calibration table. His operated foot was placed in a special shoe, the axis of which coincided with that of the ankle joint. A pulley system with known weights was used to dorsiflex the foot. Taking into consideration the geometrical arrangement of the AT transducer, axis of rotation, and the pulley system, the exact values of AT forces could be calculated. The actual measurements incorporate the use of EMG recordings of the leg extensor muscles and various external force measurements, such as long force platform or oscillating ergometers. The transducer is removed immediately after the measurements and the subjects recover.

Achilles Tendon↗