Postoperative Febrile Morbidity Research Articles

Carbon dioxide laser vaporization of intestinal metastases of epithelial ovarian cancer.

Purpose To determine the efficacy and morbidity of carbon dioxide laser vaporization of intestinal metastases of epithelial ovarian cancer. Patients and methods Following maximum surgical cytoreduction, 20 patients were treated with laser vaporization of serosal and mesenteric metastases with a carbon dioxide hand-held laser at a median wattage of 25 watts using a super-pulse mode. The maximum diameter of intestinal metastases ranged from 1 mm to 2 cm and the number ranged from 1 to> 100 implants. These patients were compared with 20 matched controls. Results Median laser time was 7 min and no patient experienced bleeding> 15 ml. Eighteen patients (90%) had no gross residual disease following laser vaporization compared to five (25%) of the controls (P = 0.0001). Nineteen patients (95%) had no gross intestinal residual disease following laser vaporization compared to eight (40%) of the controls (P = 0.01). There was no difference in the incidence of postoperative ileus, wound infection or febrile morbidity between the groups. No patient in either group developed bowel obstruction, perforation, fistula, peritonitis or abscess. Conclusion Carbon dioxide laser vaporization of intestinal metastases of epithelial ovarian cancer represents intensive cytoreduction which results in superior debulking and does not appear to increase postoperative morbidity.

The role of antibiotic prophylaxis for tubal microsurgery.

Antibiotic prophylaxis is effective in preventing postoperative wound infections and pelvic cellulitis for a variety of gynecologic procedures. Though frequently used, there is no uniform agreement and little data descriptive of the efficacy of antibiotic prophylaxis for infertility surgery. The purpose of the present study was to determine the incidence of postoperative infection-related complications after microsurgical tubal repair for infertility and to assess the possible role (if any) of antibiotic prophylaxis for tubal surgery. Retrospective; non-comparative; descriptive. Three hundred and forty-eight tubal procedures were performed over a 3 1/2 year period and included tubal reanastomosis (n = 194), distal salpingostomy (n = 107), fimbrioplasty (n = 15), and tubal reimplantation and cornual isthmic anastomosis (n = 32). All procedures were performed under general anesthesia using standard microsurgical techniques. No prophylactic antibiotics were given. When used, the operating microscope was not draped. Patients were monitored postoperatively for any infection-related complications to include postoperative febrile morbidity, wound infections, and pelvic cellulitis. A computer search of discharge diagnoses and chart review was made to determine the postoperative outcome and hospital course. There were 3 cases of febrile morbidity without localizing signs (0.8%), 3 wound infections (0.8%), 2 incisional seromas (0.5%), and one case of pelvic cellulitis (0.2%). There were no cases of bacteremia, septic shock, or septic pelvic vein thrombophlebitis. All patients responded promptly to incisional drainage or combination antibiotic therapy. Data of the present study suggest that the incidence of infection-related complications after tubal surgery without antibiotic prophylaxis is very low. These data suggest that for tubal microsurgery where hemostasis is precise and tissue handling gentle, prophylactic antibiotics may not be necessary. Antimicrobials for prophylaxis, in these circumstances, may offer no advantage in reducing infectious complications that are already extremely low and may in fact cause unfavorable selective processes on endogenous flora and untoward side effects in selected individuals.

Total abdominal hysterectomy at abdominal sacrovaginopexy: A comparative study

This study was designed to address whether women undergoing total abdominal hysterectomy at the time of abdominal sacrovaginopexy have a higher incidence of early postoperative febrile morbidity defined as an oral temperature > 35 degrees C (101 degrees F) on at least two occasions in the first 5 postoperative days when compared with women undergoing abdominal sacrovaginopexy alone. A prospective cohort study was performed in a tertiary care gynecologic urology clinic. Two hundred thirty-five patients were included in this study. Eighty-six (36.6%) underwent total abdominal hysterectomy in addition to abdominal sacrovaginopexy, whereas 149 (63.4%) had abdominal sacrovaginopexy alone, according to a standard protocol. Data were collected by chart review and analyzed with odds ratio and Student t statistics. The incidence of febrile morbidity was 4.7% in the group undergoing hysterectomy and 5.4% in the group having only abdominal sacrovaginopexy. The generated odds ratio (95% confidence interval) is 0.86 (0.21 to 3.28), which suggests no significant increase in febrile morbidity in the hysterectomy group. Similarly, no obvious difference was found in the duration of hospitalization or the change in hemoglobin between groups. There was, however, a significantly increased operating time in those patients undergoing hysterectomy. Total abdominal hysterectomy performed at the time of abdominal sacrovaginopexy does not result in a clinically significant increased risk of febrile morbidity.

Prophylactic amoxicillin-clavulanic acid in elective cesarean section

In a double-blind, randomized, controlled trial, the efficacy of intravenous amoxicillin-clavulanic acid (Augmentin®) in preventing post-cesarean section infections was studied in 35 healthy women undergoing elective lower segment cesarean section. Intravenous Augmentin or a placebo was administered before the operation. Both groups were comparable in terms of patient characteristics and operation variables. The group receiving Augmentin had no postoperative febrile or infectious morbidity. A larger proportion of patients in this group spent fewer days in hospital than those in the placebo group.

Surgical treatment of symptomatic colorectal endometriosis

The approach to the treatment of bowel endometriosis has varied greatly. In this paper we present 77 consecutive patients with deep colorectal endometriosis treated with a full-thickness resection. Gynecologic procedures included conservative laparotomies for preserving fertility (39 patients); hysterectomy with bilateral salpingo-oophorectomy (29 patients); bilateral salpingo-oophorectomy (2 patients); left salpingo-oophorectomy (1 patient) and resection of pelvic endometriosis in patients with previous ablative surgery (6 patients). A low anterior bowel resection was performed in 68 patients (88.3%); a disc excision of the anterior rectal wall in 5 (6.5%); sigmoid resection in 3 (3.9%), and partial cecal resection in 1 (1.3%). The postoperative febrile morbidity was 10.4%, with no apparent anastomotic leaks. Of 33 patients who attempted to conceive postoperatively, 13 achieved a term pregnancy (39.4%). Complete relief of pelvic symptoms was obtained in 38 patients (49.4%); improvement in 30 (39%); no improvement in 8 (10.4%); and worsening of symptoms in 1 (1.2%). There has been no recurrence of symptomatic bowel endometriosis during 1 to 9 years of follow-up. Full-thickness resection of the colon for the treatment of deep bowel endometriosis is a safe procedure with low morbidity, good postoperative relief of symptoms, and favorable pregnancy rates.

Antibiotic Prophylactic Uterine Lavage in Cesarean Section: A Double-Blind Comparison of Saline, Ticarcillin, and Cefoxitin Irrigation in Indigent Patients

The purpose of this present study was to determine whether intraoperative antibiotic uterine irrigation was effective in reducing febrile morbidity (Part 1), and to determine whether ticarcillin disodium (Ticar) or cefoxitin sodium (Mefoxin) was the more effective solution (Part 2). The indications for cesarean section had an effect on febrile morbidity. In patients having nonelective cesarean section, febrile morbidity was high, occurring in 62.7% of the saline control group and 32.9% of those receiving ticarcillin disodium irrigation. In patients having elective cesarean section, febrile morbidity was lower (28% in the saline control group and 8.3% in the ticarcillin group [P less than or equal to .05]). Ticarcillin and cefoxitin were equal in reducing postoperative febrile morbidity. The use of prophylactic antibiotics, therefore, is indicated both in high-risk patients having nonelective cesarean section and in low-risk patients having elective repeat cesarean section.

Piperacillin for prophylaxis in gynecological surgery

The effectiveness of perioperative Piperacillin for prevention of operative-site infection after gynaecological surgery was studied in a total of 100 patients. In an open randomized clinical trial of 52 women undergoing abdominal or vaginal hysterectomy Piperacillin was compared to the combination Gentamicin/Metronidazole. Piperacillin was well-tolerated. Surgical-site infection was diagnosed in the Piperacillin group in two patients and in the Gentamicin/Metronidazole group in one patient. The occurrence of postoperative febrile morbidity was also similar between the two groups. In 48 patients undergoing complicated gynecological surgery of long duration, only Piperacillin was administered perioperatively. Thirty-five of these 48 women underwent oncological operations and the mean operative length was 3.3 h. One patient developed a transient rash after the administration of Piperacillin. No other adverse side-effects were observed. Nine of these 48 patients developed a surgical-site infection postoperatively, and this was found to be significantly more often than in the first group of 52 patients. It was concluded that Piperacillin seems to be a valuable alternative for perioperative prophylaxis in gynecological surgery. Its effectiveness in vaginal and abdominal hysterectomy is similar to the combination of Gentamicin/Metronidazole, but after complicated surgery of long duration a decreased effectiveness should be reckoned with.

Single-dose cefazolin prophylaxis for cesarean section

In a prospective, randomized trial, the efficacy of a single-dose, first-generation, long-acting cephalosporin was compared with a three-dose regimen in a group of 100 women undergoing cesarean section who were at high risk for postoperative febrile morbidity. Fifty women received a single 1 gm intravenous dose of cefazolin and 50 received 1 gm of the drug followed by two additional doses, 8 hours apart, to complete a three-dose regimen. Another 50 women, considered to be at low risk for postoperative febrile morbidity, were not given antibiotic prophylaxis. Outcomes of febrile morbidity (18% vs 12%) and particularly morbidity caused by endometritis (6% vs 8%, respectively) were similar for single-dose and three-dose groups. In the untreated low-risk group there were no cases of endometritis and the febrile morbidity was comparable to that of the prophylactically treated groups (14% vs 15%). Single-dose cefazolin prophylaxis appears to be comparable to multidose prophylaxis in reducing febrile morbidity after cesarean section.

Are preoperative antibiotics helpful in abdominal hysterectomy?

An open, randomized study to compare the effectiveness of triple-dose cefoxitin with the effectiveness of cephradine-tinidazole and with the result of nontreatment in patients undergoing abdominal hysterectomy was conducted from July 1983 to July 1984. One hundred ninety-nine patients were enrolled: 66 untreated control patients, 69 patients in the cephradine-tinidazole-treated group, and 64 patients in the cefoxitin-treated group. No significant differences were present in relation to age, pathologic condition, length of operation, blood loss, or length of hospital stay. That patients in both treatment groups had a lower incidence of postoperative febrile morbidity was not statistically significant.

Risk factors associated with infection following cesarean section

A retrospective study by means of multivariant discriminant analysis was performed on 496 deliveries (250 vaginal and 246 cesarean sections) to identify risk factors which predispose to postoperative febrile morbidity, in particular, endometritis. The infection rates for endometritis by type of delivery were: vaginal, 3.6%; elective repeat cesarean section, 6.0%; nonurgent primary cesarean section, 22.2%; and emergency cesarean section, 38.4%. No patient-related risk factors were identified for elective repeat cesarean section, and bacterial isolates were most frequentlyStaphylococcus aureus. However, four statistically significant risk factors were associated with the occurrence of endometritis after primary cesarean section. In increasing order of significance, they were duration of labor, number of preoperative vaginal examinations, time membranes were ruptured prior to delivery, and postoperative anemia. Internal fetal monitoring was not a risk factor. The clinical relevance of these findings to the use of prophylactic antibiotics and other attempts aimed at decreasing postoperative morbidity is discussed.

A DOUBLE‐BLIND TRIAL OF SINGLE‐DOSE CHEMOPROPHYLAXIS WITH CO‐TRIMOXAZOLE DURING VAGINAL HYSTERECTOMY AND REPAIR

Twenty-five patients received 10 ml co-trimoxazole (800 mg sulphamethoxazole and 160 mg trimethoprim) and 25 a placebo by intravenous infusion during one hour from the commencement of surgery for vaginal hysterectomy with anterior colporrhaphy and posterior colpo-perineorrhaphy. Single-dose chemoprophylaxis with co-trimoxazole was shown to be effective in reducing the incidence of postoperative febrile morbidity and urinary tract infection, especially that caused by Proteus species.

Preoperative hot conization of the cervix: A possible method to reduce postoperative febrile morbidity following vaginal hysterectomy

Laboratory results indicate that the endocervix may be a source of bacterial contamination when vaginal hysterectomy is performed. In a series of 160 consecutive vaginal hysterectomies in premenopausal women, hot conization of the cervix was performed prior to the scrub with an iodophore. No preoperative antibiotics were used in this series. The postoperative febrile morbidity rate was 4.3 per cent and the average stay was 4.5 days. These results are compared with those of three other groups: (1) patients who received a three-dose parenteral prophylactic antibiotic course with the first dose two hours prior to surgery had a febrile morbidity rate of 8.6 per cent. (2) In patients who had prophylactic antibiotics for five days with the first dose given intraoperatively, the febrile morbidity rate was 10.1 per cent. (3) The febrile morbidity rate in the group with no antibiotic prophylaxis or hot conization was 49.1 per cent. Laboratory and clinical data suggest that preoperative conization may be effective in the reduction of postoperative febrile morbidity.

Prophylactic antibiotics in high-risk cesarean section.

A brief perioperative course of ampicillin was recommended for high-risk patients undergoing cesarean section at our institution. High-risk patients were defined as those with two or more of the following factors: general anesthesia, obesity, hematocrit less than or equal to 30%, and labor prior to delivery. Fifteen percent of high-risk patients who received prophylactic antibiotics experienced postoperative febrile morbidity compared to 63% for the high-risk untreated group (P less than 0.001). Twenty-five percent of low-risk patients (less than 2 risk factors) developed this complication. Endometritis was the leading cause of postoperative febrile morbidity. Postoperative stay was only slightly decreased in the prophylactically treated group (5.9 vs 6.2 days). Prophylactic amplicillin given perioperatively was an effective agent in reducing post-cesarean-section febrile morbidty among high-risk patients.

Extraperitoneal cesarean section: A new need for old skills: A preliminary report

Preliminary results of the effect of extraperitoneal cesarean section on operative and postoperative morbidity are presented. The extraperitoneal technique did not prolong delivery time or operative time, as compared to transperitoneal cesarean section. Postoperative febrile morbidity seemed to be less in the patients who had extraperitoneal cesarean section, even when compared to randomly selected transperitoneal cases. Further data will be necessary to conclude that renewed interest in this technique is warranted.

Infectious Diseases in Obstetrics and Gynecology

Today's obstetrician-gynecologist finds himself uncommonly concerned with chorioamnionitis, puerperal sepsis, postoperative febrile morbidity, the venereal diseases, "prophylactic" antibiotic therapy, anaerobic infections, and the like. There is, to my knowledge, no more current, readily available, or comprehensive reference work than this excellent text by Monif and 15 contributors. The text is divided into four sections; of these, section II ("Organisms") is concerned in the main with viral, bacterial, protozoal, fungal, and spirochetal infections. Every chapter is current, timely, informative, and useful to the clinician. This section comprises one half the text and is sufficiently strong to stand alone. In contrast, section I ("General Considerations") could easily have been omitted. Or it might have been replaced by a chapter, such as chapter 23 of section IV ("Problem Areas: Gynecological"), which is written by Bill Ledger and is entitled "Anaerobic Infection." Dr. Ledger addresses the problem immediately in this chapter, describing the huge

Pelvic Infections Following Vaginal Hysterectomy

An effort to develop a workable plan for reducing the present high incidence of postoperative febrile morbidity led to a reopening of the question of preoperative antibiotic prophylaxis. A test based on the view that the operative site be considered “potentially contaminated” is reported; while the study did not seek to prevent all infections, its findings indicate that the incidence can be cut by about one half.

Comparison of single versus multiple doses of antibiotic prophylaxis in reducing post-elective Caesarean section infectious morbidity

Puerperal sepsis is frequently in Caesarean section. Antibiotic prophylaxis may have significant impact in reduction of infections and thus the need to study its role in sepsis prevention systematically. The aim of this study is to compare the efficacy of single dose versus multiple doses of a first generation cephalosporin (with Metronidazole), to reduce postoperative infectious morbidity in elective caesarean section. It was prospective clinical trial of hundred women undergoing elective caesarean section who received either a single prophylactic dose of Cefazolin with Metronidazole post-cord clamping, or multiple postoperative doses of antibiotics based on the standard protocol of the hospital. Duration of the study was seven months and twenty-two days (11th November 2004 to 30 th June 2005).Women were compared on the basis of development of postoperative febrile morbidity, endometritis, urinary tract infection, wound infection and other infections. There were no significant differences among the patients in single and multiple dose groups in terms of their age distribution, gravida, period of gestation, smoking status, body mass index, indications for elective caesarean section or operation characteristics. There were 4% and 6% febrile morbidity, 2 (4%) and 0 (0%) urinary tract infection, in the single dose and multiple dose groups respectively. But none of the differences were statistically significant. A single prophylactic dose of Cefazolin plus Metronidazole given post-umbilical cord clamping gives as much protection as multiple postoperative doses of Cefazolin/Cefalexin plus Metronidazole in preventing postoperative infectious morbidity in elective caesarean section.