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,...
Objectives. To evaluate risk factors and to develop a simple scoring system to grade the risk of postoperative hypothyroidism (PH). Methods. In a controlled prospective study, 109 patients, who underwent hemithyroidectomy for a benign thyroid disease, were followed up for 12 months. The relation between clinical data and PH was analyzed for significance. A risk scoring system based on significant risk factors and clinical implications was developed. Results. The significant risk factors of PH were higher TSH (thyroid-stimulating hormone) level and lower ratio of the remaining thyroid weight to the patient's weight (derived weight index). Based on the log of risk factor, preoperative TSH level greater than 1.4 mU/L was assigned 2 points; 1 point was for 0.8–1.4 mU/L. The derived weight index lower than 0.8 g/kg was assigned 1 point. A risk scoring system was calculated by summing the scores. The incidences of PH were 7.3%, 30.4%, and 69.2% according to the risk scores of 0-1, 2, and 3. Conclusion. Risk factors for PH are higher preoperative TSH level and lower derived weight index. Our developed risk scoring system is a valid and reliable tool to identify patients who are at risk for PH before surgery.
The prognostic index has good diagnostic accuracy but dividing patients into two risk groups is insufficient. The suggested model allows determining an intermediate-risk group, which requires additional investigation. Both management approaches are appropriate.
Patients and methodsWe performed a retrospective analysis of eight patients who underwent a retroperitoneoscopic pancreatic necrosectomy in the Center of Abdominal Surgery, Vilnius University Hospital Santariškių Klinikos, between 2007 and 2009. There were six males and two females aged between 25 and 58 years. In seven cases, pancreatitis was caused by alcohol consumption; in one case, by gallstones. Two patients had pancreatic necrosis in the pancreatic head and tail (>50% and 30-50%), two patients had 30-50% pancreatic necrosis in the pancreatic body and tail, and four patients had >30% pancreatic necrosis in the pancreatic tail. In all cases, necrosis was proved by CT scan. Seven patients had extensive retroperitoneal phlegmon on the left side, and one patient on both sides. Operations were performed on the 21st-56th day of illness (average, 36th day), after infection of pancreatic necrosis was proved by fi ne-needle aspiration under ultrasound guidance. We used an original technique, developed in our center. A patient was placed in the right lateral decubitus position and bent at the waist with help
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.