Background: There is controversy regarding the effectiveness of postoperative antibiotics to prevent wound infection. Some surgeons still use a routine postoperative oral antibiotic regimen. The purpose of this study was to review a series of cases and document statistically any difference in infection rates and whether routine postoperative antibiotics in foot and ankle surgery are justified. Methods: A retrospective chart review of 649 patients was performed who underwent elective foot and ankle surgery. Six hundred thirty-one patient charts were included in the final analysis. Evaluated were patients who did and did not receive postoperative oral antibiotics in order to identify whether a difference in infection rate or wound healing occurred. The study also evaluated risk factors for developing infection following foot and ankle surgery. Results: The number of infections in patients receiving postoperative oral antibiotics was 6 (3%), while the number of infections in those who did not receive postoperative oral antibiotics was 10 (2%) ( P = .597). The difference of deep versus superficial infections and delays in wound healing between the 2 groups was not statistically significant. Patients who developed infections were older and had a higher prevalence of hypertension, a history of neoplasm, and a greater American Society of Anesthesiologists Classification of Physical Health. Conclusion: This study suggests that routine use of postoperative antibiotics in foot and ankle surgery does not affect wound complications or infection rates. Additionally, patients who are older and those with multiple medical problems may be at higher risk for developing postoperative infection following foot and ankle surgeries. Level of Evidence: Level III, retrospective comparative series.
Background: Drains are used in plastic surgery to remove excess fluid while ameliorating complications. However, there is a paucity of evidence supporting guiding parameters on when to discontinue a drain. The aim of our study was to determine whether two of the most common parameters, drain volume 24 hours before removal or postoperative day, are valid indicators for drain removal. Methods: A retrospective chart review was conducted for surgical operations performed by our division between July 2014 and May 2019. Of the 1308 patients, 616 had a drain and a complete record. Demographics, medical history, operative time, antibiotic use, anatomic site, donor/recipient, and complication type were recorded. Complications were defined as events that deviated from expected postoperative course or required pharmacological/procedural intervention. T -test and Chi square were used to analyze data. Results: In total, 544 patients were in the no complication group, and 72 were in the complication group. The complication group patients had drains removed later than patients in the no complication group (15.7 days versus 12.5 days, P = 0.0003) and had similar final 24-hour drain volumes versus patients in the no complication group (16.7 mL versus 18.8 mL, P = 0.2548). The complication group had more operations on the pelvis (11% versus 2.1%; P = 0.000017) or thigh (8.5% versus 3.4%; P = 0.029). Conclusions: Our data suggest neither postoperative day nor 24-hour volume before drain removal are valid indicators for removal. Late removal correlates with more complications; however, persisting output leading to later removal may be predictive of an impending complication rather than delays in drain removal causing the complication.
Professional boundaries promote safe and effective healthcare. Whilst sexual boundary violations have been a research focus, it has been suggested that non-sexual boundary violations may represent a ‘slippery slope’, whereby crossing relatively minor boundaries can progress to serious boundary violations. Medical school presents an opportunity to support medical students with strategies to manage boundary challenges more effectively as doctors. The current study aimed to examine medical students’ awareness and confidence in managing boundary crossings and compare findings across year groups. Students in years 1, 3 and 5 of a five-year undergraduate program at one medical school in Australia, were invited to participate in an anonymous online survey which used multiple choice and free text questions to explore reactions to five scenarios demonstrating some level of boundary crossing. Students were asked about prior training and suggestions for future training. Quantitative data was analysed using omnibus chi-square tests and Kruskal-Wallis one-way ANOVAs for non-parametric data; free text data was analysed using coding and grouping similar themes. Final year students most accurately identified boundary crossings yet were somewhat more willing to cross ‘grey’ or less clear-cut boundaries. Year 3 students consistently reported the lowest levels of confidence in managing scenarios. Students reported little to no formal teaching relevant to the scenarios presented and supported inclusion of education regarding boundary issues in formal curricula. Our findings further suggest a need for education regarding management of the clinician-student power dynamic and there is demand from students for more teaching and support around ‘grey’ boundary crossings.
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