SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

Background: Surgical site infection (SSI) is one of the most common complications of abdominal surgery and is associated with substantial discomfort, morbidity and cost. The goal of this study was to describe the incidence, bacteriology and risk factors associated with SSI in patients undergoing abdominal surgery. Methods: In this prospective cohort study, all patients aged 14 years or more undergoing abdominal surgery between Feb. 1 and July 31, 2016, at a single large academic hospital were included. Patients undergoing vascular, gynecological, urological or plastic procedures were excluded. Patients were followed prospectively for 30 days. Wound assessment was done with the Centers for Disease Control and Prevention definition of SSI. We performed multivariate analysis to identify factors associated with SSI. Results: A total of 337 patients were included. The overall incidence of SSI was 16.3% (55/337); 5 patients (9%) had deep infections, and 25 (45%) had combined superficial and deep infections. The incidence of SSI in open versus laparoscopic operations was 35% versus 4% (p < 0.001). The bacteria most commonly isolated were extended-spectrum β-lactamase-producing Escherichia coli, followed by Enterococcus species. Only 23% of cultured bacteria were sensitive to the prophylactic antibiotic given preoperatively. The independent predictors of SSI were open surgical approach, emergency operation, longed operation duration and male sex. Conclusion: Potentially modifiable independent risk factors for SSI after abdominal surgery including open surgical approach, contaminated wound class and emergency surgery should be addressed systematically. We recommend tailoring the antibiotic prophylactic regimen to target the commonly isolated organisms in patients at higher risk for SSI. Contexte : L'infection de plaie opératoire (IPO) est l'une des plus fréquentes complications de la chirurgie abdominale et elle est associée à un inconfort, une morbidité et des coûts substantiels. L'objectif de cette étude était de décrire l'incidence, les données bactériologiques et les facteurs de risque associés à l'IPO chez les patients soumis à une chirurgie abdominale. Méthodes : Dans cette étude de cohorte, tous les patients de 14 ans ou plus soumis à une chirurgie abdominale entre le 1 er février et le 31 juillet 2016 dans un seul grand établissement hospitalier universitaire ont été inclus. Les chirurgies vasculaires, gynécologiques, urologiques ou plastiques ont été exclues. Les patients ont été suivis de façon prospective pendant 30 jours. L'évaluation des plaies a été effectuée à partir de la définition de l'IPO des Centers for Disease Control and Prevention. Nous avons procédé à une analyse multivariée afin d'identifier les facteurs associés à l'IPO. Résultats : En tout, 337 patients ont été inclus. L'incidence globale des IPO a été de 16,3 % (55/337); 5 patients (9 %) ont présenté des infections profondes, et 25 (45 %) ont présenté des infections superficielles et profondes. L'incidence des IPO lors d'interventions ouvertes ...

No abstract

Purpose Thymic epithelial neoplasms (TEN) represent a heterogeneous group of rare thoracic malignancies. We analyzed the clinicopathological features, survival outcomes, risk factors, and patterns of recurrence in patients undergoing resection. Methods Records were reviewed for adult patients with TEN who underwent resection from 2006-2019. Survival rates were assessed using the Kaplan-Meier method. Univariable and multivariable analyses were performed using the log-rank test and Cox proportional hazards model. Results A total of 100 patients were analyzed (51 females, median age 58 years). Thymoma was the most common histology (n = 92), followed by thymic carcinoma (n = 5), and thymic NET (neuroendocrine tumor) (n = 3). Stage II (Masaoka) tumours were most common (n = 51), followed by stage I (n = 27). WHO B2/B3 was the most prominent histological subtype (n = 34). Complete resection (R0) was achieved in 91 patients: 86/92 thymoma, 4/5 thymic carcinoma and 1/3 NET. The most common treatment modality was surgery alone in 72 patients, followed by surgery and radiation therapy in 24, and adjuvant chemoradiotherapy in 3 patients. Only one patient with thymic carcinoma received neoadjuvant chemotherapy. The 10-year overall and disease-free survival rates were 86.6% and 83.9%, respectively. Recurrence was most common in NETs (3/3). Risk factors for recurrence identified on multivariable analyses were: R1/2 resection (HR 9.30, 95%CI 1.82-36.1), TEN subtype (HR 8.08, 95%CI 1.24-34.6), and presence of lymphovascular invasion (LVI) (HR 9.56, 95%CI 2.56-25.8). Conclusion Complete resection remains critical in patients with TEN. Incomplete resection, high-risk histology and LVI highlight the need for effective adjuvant modalities. Given the rarity of these diseases, emphasis must be placed on collaborative research conducted on TEN.

Background: This study assesses whether patients with ischemic heart disease receive comparable care and achieve similar outcomes compared to the rest of patients in the department of medicine at our tertiary academic center. Methods: This retrospective study examined the level of care received by all patients who were admitted to the Internal Medical Services at King Abdulaziz University Hospital from January 2010 through December 2012. A number of potential performance indicators were evaluated to ascertain level of care, including clinical deterioration with unplanned intensive care unit transfers, in-hospital complications, in-hospital mortality, and the rate of 30-day readmission. The t test or Mann-Whitney U-test was used to compare means and medians, respectively. The chi-square test was used to compare categorical variables. Results: Of 3838 patients, about a fifth of ischemic heart disease patients (19.3%) required intensive care unit transfer (P < 0.001). Patients admitted through the emergency department were the largest group to require subsequent intensive care unit transfer (65.9% of all cases). The length of stay was significantly shorter in patients admitted to the cardiac care unit, compared with those admitted to other services (3.5 [1.5] days versus 5.8 [5.5] days for patients admitted to other units; P < 0.001). Thirty-day readmission rate was significantly lower in ischemic heart disease patients (11.7%) compared with non- ischemic heart disease cases (18.5%) (P < 0.0001).