Objective: Antibiotics can be prescribed as prophylaxis against surgical site infection (SSI) in dermatological surgery. In accordance with antibiotic stewardship, clinical evidence should inform judicious antibiotic prescribing. This review aimed to identify patient and procedure related risk factors for SSI following minor dermatological surgery. Data sources: MEDLINE, CINAHL, Informit and Scopus databases were searched for relevant literature on patient populations receiving minor surgery, where risk factors for SSI were explicitly stated. Study Selection: Studies involving major dermatological surgery were excluded. The preliminary search yielded 820 studies after removing duplicates. 210 abstracts were screened, and 42 full texts were assessed for eligibility. A total of 13 papers were included. Studies were appraised using the Newcastle-Ottawa Quality Assessment Scale. Data Extraction: An electronic data collection tool was constructed to extract information from the eligible studies, and distributed to participating authors. Data synthesis: Risk factors identified included age, sex, diabetes mellitus, chronic obstructive pulmonary disease (COPD), anti-hypertensive and corticosteroid use, smoking, surgery on the lower or upper extremities, excision of non-melanocytic skin cancers (NMSC), large skin excisions and complex surgical techniques. A maximum of two studies agreed on any one risk factor and there were insufficient studies for meta-analysis. Conclusions: Re-excision of skin cancer, below knee excisions and intra-operative haemorrhagic complications were predictive for infection in more than one study. More highquality studies are required to accurately identify risk factors so they can be reliably used in clinical guidelines. the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America is that antibiotic therapy should be based on patient specific factors, 3 hence an awareness of patients who are at higher risk of SSI is necessary to encourage more judicious antibiotic prescribing. To accurately define patient groups predisposed to developing a SSI, a comprehensive understanding of patient, procedural and physician related risk factors is necessary. Extensive clinical studies have investigated these risk factors in small to large cohorts, however to our knowledge few studies have presented a large systematic review of all possible risk factors which contribute to an individual's overall risk of infection. This review aims to systematically appraise the current evidence of risk factors for SSI in minor dermatological surgery, and identify where further research may be required. Methods Protocol/registration The systematic review was registered in the PROSPERO international prospective register of systematic reviews (ID CRD42016045830). Eligibility criteria Two eligibility criteria were applied in this review. The first was based on a population, intervention, comparison and outcome (PICO) strategy (Table 1). Eligible papers examined

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Background Failure to rescue (FTR) is increasingly recognised as a measure of the quality care provided by a health service in recognising and responding to patient deterioration. We report the association between a patient’s pre-operative status and FTR following major abdominal surgery. Methods A retrospective chart review was conducted on patients who underwent major abdominal surgery and who suffered Clavien–Dindo (CDC) III-V complications at the University Hospital Geelong between 2012 and 2019. For each patient suffering a major complication, pre-operative risk factors including demographics, comorbidities (Charlson Comorbidity Index (CCI)), American Society of Anaesthesiology (ASA) Score and biochemistry were compared for patients who survived and patients who died. Statistical analysis utilised logistic regression with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). Results There were 2579 patients who underwent major abdominal surgery, of whom 374 (14.5%) suffered CDC III-V complications. Eighty-eight patients subsequently died from their complication representing a 23.5% FTR and an overall operative mortality of 3.4%. Pre-operative risk factors for FTR included ASA score ≥ 3, CCI ≥ 3 and pre-operative serum albumin of < 35 g/L. Operative risk factors included emergency surgery, cancer surgery, greater than 500 ml intraoperative blood loss and need for ICU admission. Patients who suffered end-organ failure were more likely to die from their complication. Conclusion Identification of patients at high risk of FTR should they develop a complication would inform shared decision-making, highlight the need for optimisation prior to surgery, or in some cases, result in surgery not being undertaken.

Cite this article as: Marlon Perera, Pranav Divakaran, Matthew Roberts and Eric Chung, Comparative trial assessing suture techniques and types of urinary catheters in vesicourethral anastomotic tensile strength in a porcine model, Journal of the Mechanical Behavior of Biomedical Materials, http://dx.doi.org/10.1016Materials, http://dx.doi.org/10. /j.jmbbm.2016 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. MethodsMale porcine bladders were obtained and prostatectomy was performed. The specimens were randomized and VUA were created using 3-point interrupted, 6-point interrupted or 6 point continuous 3-0 monocryl suture. 20Fr catheters were utilized, specifically varying manufacturers (A and B) and catheter balloon shapes (round versus oval). The VUA model was placed within a reproducible pulley system and graduated weights were applied util failure of the catheter balloon or the model VUA. Model failure was defined as either 'VUA rupture', 'Catheter passage through VUA' or 'catheter failure'. ResultsTwenty consecutive porcine bladders were prepared, tested and utilized for analysis. VUA reconstructed with 3-point fixation was more likely to suffer VUA rupture (p=0.025) compared to 6-point interrupted or 6-point continuous VUA. Higher tensile pressure causing catheter balloon rupture (p=0.009) was observed for Manufacturer A. Catheters with ovalballoon shape were more likely to dislodge past the VUA without disruption of the anastomosis (p=0.002). ConclusionsDuring prostatectomy, anastomotic technique and catheter selection can significantly alter the tensile properties of the VUA. Further research is required to validate our findings in clinical models.3

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