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At least 127 records · Page 7Linked to original sources
PubMed1997

Association of secundum atrial septal defect and mitral lesion in childhood: a case report.

The association of secundum atrial septal defect (ASD) and congenital or acquired mitral lesions is rare. Only one case of secundum ASD and mitral lesion, in a three-year-old girl, has been encountered over a three-year period in this hospital. Diagnosis was not difficult with echocardiography, and was confirmed by operation. Surgical procedures including repair of ASD and annuloplasty of the mitral valve were performed under cardiopulmonary bypass. The mitral valve lesion was found during the operation to be of a congenital origin. Mitral lesions should not be neglected, and repair should be attempted even in a pediatric patient. Otherwise, anatomical and functional disorders of the mitral valve may develop at the early postoperative stage.

Child, Preschool↗
PubMedDate not supplied

Effective and creative surveillance and reporting of surgical wound infections.

Surgical wound infections offer a major challenge to hospital infection control programs. Surgical procedures and host factors are independent variables which markedly influence the risk of infection. Frequently used categories of surgical procedures (clean, contaminated, and infected) are inadequate to identify the special risks and problems of individual procedures. In 1976, in conjunction with the practicing surgeons of a large, referral hospital, the Infections Control Committee instituted surveillance of selected clean surgical procedures and deep-versus-superficial wound infections. Major problems associated with the cleaning of sternal saws and the timing of the administration of prophylactic antibiotics have been detected by these methods. Conventional surveillance undoubtedly would have overlooked these problems. Effective surveillance and control of surgical wound infections requires a willingness to modify surveillance activities to meet the local needs, and a determination to include the operating surgeons in the planning of surveillance activities.

Hospital Bed Capacity, 500 and over↗
PubMedDate not supplied

Transthoraco-phrenic esophageal transection with paraesophago-gastric devascularization and splenectomy using a stapler.

BACKGROUND/AIMS: Surgery remains the most reliable treatment for bleeding esophageal varices. The aim of this study was to introduce the operative technique of transthoraco-phrenic esophageal transection with paraesophagogastric devascularization using a stapler and to evaluate surgical results. METHODS: Forty-five patients underwent the procedure; an elective procedure was performed in 22 patients (bleeders) and a prophylactic procedure in 23 patients (nonbleeders). Twenty-nine patients were classified as Child's A, 15 as B and 1 as C. Previous sclerotherapy had been performed in 5 patients. RESULTS: No hospital deaths occurred. No patients developed postoperative anastomotic leakage, encephalopathy, or any complications related to phrenicotomy. Three patients bled postoperatively from recurrent esophageal varices. Cumulative 5-year bleeding rates were 5.0% in bleeders and 6.6% in non-bleeders. Two patients died due to bleeding varices. Cumulative 5-year survival rates were 72.1% and 78.8% in patients classified as Child's A and Child's B, respectively. CONCLUSIONS: This procedure may be indicated for a majority of Child's A or B patients. Although the advantages of this procedure must be evaluated further, it may be an alternative when injection sclerotherapy and endoscopic ligation fail.

Adult↗
PubMed2003

Surgical wound infection surveillance in general surgery procedures at a teaching hospital in Pakistan.

BACKGROUND: A surveillance system was established at the Aga Khan University Hospital in Karachi, Pakistan, to determine surgical wound infection (SWI) rates, trends, and risk factors; and to compare rates with those reported by the National Nosocomial Infection Surveillance (NNIS) system of the Centers for Disease Control and Prevention. METHODS: Surveillance was performed from January 1997 to December 1999. Risk categorization was on the basis of the NNIS system. P <.05 was set for statistically significant difference between groups. Data were analyzed using the Epi-Info software (version 6.04, CDC, Atlanta, Ga). RESULTS: Overall SWI rates for the NNIS risk categories 0, 1, 2, and 3 were 1.9%, 3.7%, 6.7%, and 5.1%, respectively. SWI rate in 0 risk category decreased from 3% in 1997 to 1.1% in 1999 (P =.06). Multivariate analysis showed that SWI rates were higher after mastectomy (odds ratio [OR] 4.28, 95% confidence interval [CI] 1.8-10), hernia repair (OR 3.28, 95% CI 1.6-6.7), gastrointestinal resection (OR 2.2, 95% CI 0.88-5.9), skin procedures (OR 1.97, 95% CI 0.89-4.3), appendectomy OR 0.57, 95% CI 0.20-1.60, and miscellaneous procedures (OR 3.6, 95% CI 1.6-7.7), as compared with cholecystectomy. Other risk factors were contaminated type of operation (OR 2.6, 95% CI 1.2-5.5), and duration of operation exceeding the NNIS standard of "T" hours (OR 2.6, 95% CI 1.7-4). CONCLUSION: The SWI rates at the Aga Khan University Hospital are higher than the NNIS standards. There was a downward trend in the SWI rates during the surveillance period. A decrease in the duration of surgical procedures could further reduce the risk.

Cross Infection↗
PubMed1998

Surgical site infections.

The New CDC-definitions for surveillance of surgical site infections (1992) take into account 3 classes of surgical site infections (SSI): superficial and deep incisional SSI, and organ/space SSI. The most important host-related risk factors for development of SSI are advanced age, morbid obesity, disease severity, an ASA score > 2, prolonged preoperative hospital stay, and infection at distal sites. Microbial contamination of the surgical site occurs mainly during the surgical intervention. Although exogenous contamination may be of concern, especially in clean operations, most surgical site infections are caused by microorganisms of the patient's own commensal flora. SSI rates vary according to the type and duration of the surgical procedure and the skill of the surgeon. Proper surgical technique is the most important factor in the prevention of SSI. Modification of host risk factors should be attempted whenever possible. In addition, adequate protocols for antimicrobial prophylaxis with antibiotics should be followed. Surveillance of surgical site infections is probably beneficial for SSI prevention.

Age Factors↗
PubMed1989

[Surgical treatment of spinal kyphosis following congenital hemivertebra].

The results of surgical treatment of 16 cases of spinal kyphosis following congenital hemivertebra are reported. A satisfactory correction was obtained by use of a combined anterior and posterior operative procedure. Surgical treatment is indicated for prevention, and our treatment of congenital spinal kyphosis in this series was excellent without serious postoperative complication.

Adolescent↗
PubMed1999

Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues.

The influence of recently published guidelines by the Surgical Infection Society (SIS) on current surgical practice are not well documented. The appropriateness of antibiotic administration in a cohort of surgical patients undergoing elective and emergency surgery in a department of surgery in an urban, community-based, private, 560-bed teaching hospital was retrospectively reviewed. The following were the criteria defining administration as appropriate as modified from SIS guidelines: Prophylactic use: (1) started prior to operation; (2) spectrum appropriate to the specific operation; (3) duration </= 24 hours. Therapeutic use: (1) started prior to operation; (2) spectrum appropriate to pathology; (3) Duration </= 24 hours for contamination or "resectable" infection and </= 5 days for established infection in the absence of clinical evidence of persisting infection. Any switchover from an appropriate agent to another appropriate or inappropriate agent in the same patient in the absence of microbiologic or clinical indication was considered inappropriate administration. We reviewed the charts of 211 randomly selected patients who underwent elective (n = 132) or emergency (n = 79) procedures during 1996. The operations included gastrectomy (n = 22), appendectomy (n = 27), open (n = 5) or laparoscopic (n = 27) cholecystectomy, colectomy (n = 28), hysterectomy (n = 8), laparotomy for intestinal obstruction (n = 11), mastectomy (n = 26), and ventral hernia repair (n = 37). A total of 17 antibiotics were used for prophylaxis and 21 for therapy. In 156 patients (74%) the administration was considered inappropriate. Eight patients in the inappropriate group developed diarrhea (two cases of Clostridium difficile-induced colitis) compared to two cases of diarrhea in the appropriate group (nonsignificant). The average duration of administration after elective and emergency operations was 3.3 and 5. 7 days, respectively. The total expense for excessive duration of administration was $18,533. Many surgeons are not familiar with the spectrum of antimicrobials and often do not distinguish between prophylactic and therapeutic administration. Antibiotic usage in current surgical practice is often inappropriate, excessive, and chaotic.

Anti-Bacterial Agents↗
PubMed2001

[Evaluation of efficacy of selected antiseptics for hands disinfection before surgical procedures].

The most important in surgical hands washing and disinfections is long-term and effective reduction of bacteria number. The aim of this study was to compare the efficiency of some antiseptic fluids used for surgical hands disinfection's (AHD 2000, Biotensid, Manopronto and Medi-Scrub PVP Iodine). 62 doctors and surgical nurses were examined. The material for the bacteriological examination was collected before and after hands disinfection's. The bacterial flora reduction have been presented as a percent and a logarithmic reduction ratio. All estimated antiseptic fluids were very potent and provided prolonged efficiency when the operation team complied with orders of hands washing.

Anti-Infective Agents, Local↗
PubMed2006

Timely administration of prophylactic antibiotics for major surgical procedures.

BACKGROUND: Prophylactic antibiotics (PA) given within 60 minutes before surgical incision decrease risk of subsequent surgical site infection. Nationwide quality improvement initiatives have focused on improving the proportion of patients who receive timely prophylactic antibiotics. STUDY DESIGN: This is a cohort study of major surgical procedures performed in 108 Veterans Affairs hospitals between January and December 2005. Using data from the External Peer Review Program and the National Surgical Quality Improvement Program, we examined factors associated with timely PA administration. Univariate and multivariable analyses were performed. RESULTS: There were 8,137 major surgical procedures: cardiac (2,664), hip and knee arthroplasty (3,603), colon (1,142), arterial vascular (606), and hysterectomy (122). Timely PA occurred in 76.2% of patients, 18.2% received them too early, and 5.4% received them too late. Early administration accounted for 79% of untimely PA. Differences in timeliness were seen by procedure type (68% to 87%; p < 0.0001), admission status (67% to 80%; p < 0.0001), and antibiotic class (65% to 89%; p < 0.0001). PA administration occurred in the operating room for 63.5% of patients. When PA administration occurred in the operating room, they were timely in 89% of patients, compared with 54% of patients where administration was outside the operating room (odds ratio, 7.74; 95% CI = 6.49 to 9.22). CONCLUSIONS: Early PA administration accounted for the majority of inappropriately timed PA. Efforts to improve performance on this measure should focus on administering antibiotics in the operating room.

Antibiotic Prophylaxis↗
PubMed1996

Antimicrobial prophylaxis in surgery in Belgian hospitals: room for improvement.

OBJECTIVE: To evaluate the current practice of surgical antimicrobial prophylaxis in Belgium. DESIGN: Prospective multicentre incidence study. SETTING: 58 of the 206 acute hospitals in Belgium. SUBJECTS: 19746 patients who had operations between October 1992 and June 1993, with detailed analysis of 7983 procedures for which the antimicrobial regimens were known. RESULTS: Antibiotic prophylaxis was given before 14099 (71%) of the 19746 operations. It was given in 57% of the procedures for which prophylaxis is generally not recommended, but it was not used in 14% of procedures for which it is generally recommended, nor in 14% of all contaminated procedures. Duration of operation superseded degree of wound contamination, ASA (American Society of Anesthesiologists) score, and degree of urgency as a predictor of the use of prophylaxis. Prophylaxis was prolonged by more than 2 days postoperatively after 23% of the procedures and by more than 4 days in 8%. Five types of regimens accounted for 80% of all prophylaxis, but overall 234 different regimens were prescribed. Large differences were found in hospital university affiliation status. In general, trends were favourable compared with a study in 1986. CONCLUSION: Although there was improvement compared with 1986, antimicrobial prophylaxis in surgery could still be more appropriate in terms of indication, duration, and rational choice of drugs.

Antibiotic Prophylaxis↗
PubMed1990

Effect of chlorhexidine scrub on postoperative bacterial counts.

Chlorhexidine surgical scrub was left on the surgeon's hands in 50 orthopedic and vascular surgical procedures to determine whether the number of bacteria on the hands could be decreased postoperatively. After a standard 5-minute scrub, one hand was randomly rinsed prior to gloving; the other was lightly patted with a sterile towel, leaving some foam on the hand. The surgeon then gloved and performed the procedure in the usual manner. After the operation, both hands were immersed in a tryptic soy broth for 30 seconds. The broth was then cultured for bacterial species and number. Cases in which glove puncture occurred were not cultured. The results were analyzed using the Wilcoxon signed-rank test. There were fewer bacterial colonies isolated from the hand coated with chlorhexidine scrub versus the other; this difference was statistically significant (p less than 0.005). There also seemed to be a trend towards higher bacterial counts after longer operations; however, the difference was not significant. Neither surgeon noted any evidence of dermatitis during the study. These results suggest that leaving chlorhexidine scrub on the hands during surgery can lead to lower bacterial counts on the surgeon's hands and less chance of wound contamination should glove puncture occur.

Antisepsis↗
PubMed2005

Perioperative antibiotics: when, why?

The use of prophylactic antibiotics in general thoracic surgery is well established. This article explains the rationale for modern-day surgical wound infection prophylaxis, the why and the when. Various arguments about the use of antibiotics to prevent empyema and pneumonia after a thoracic operation also are presented.

Anti-Bacterial Agents↗