Postoperative Antibiotics Research Articles

Surgically treated purulent pericarditis induced by ingested fish bone: a case report

BackgroundAspiration of fish bones is common, but perforation of the gastrointestinal tract is very rare. Once perforation occurs, fatal complications such as mediastinitis and cardiac tamponade can occur. Here, we present a case of acute pericarditis due to perforation of a fish bone.Case presentationA 66-year-old woman was referred to our hospital with shortness of breath. Blood tests showed high C-reactive protein, and contrast-enhanced computed tomography showed a large amount of pericardial fluid as well as a foreign body with high bone density in the pericardial sac. Upper gastrointestinal endoscopy showed no evidence of penetration of the esophageal or gastric mucosa. Emergency open chest surgery was performed, and the pericardial sac was filled with copious amounts of pus. The fish bone-like foreign body was found to penetrate the pericardial membrane from the diaphragmatic side. The foreign body was removed, a drainage tube was placed, and the chest was closed. After 2 weeks of postoperative antibiotics, the patient was discharged from the hospital in stable general condition. Three months after the surgery, the patient had no recurrence of pericarditis.ConclusionsWe reported a rare case of gastrointestinal perforation by a fish bone, resulting in pericardium, which was treated by surgical drainage.

Standardization of Antibiotic Management and Reduction of Opioid Prescribing in Pediatric Complicated Appendicitis: A Quality Improvement Initiative

BackgroundAppendicitis is one of the most common pediatric surgical procedures in the United States. However, wide variation remains in antibiotic prescribing and pain management across and within institutions. We aimed to minimize variation in antibiotic usage and decrease opioid prescribing at discharge for children with complicated appendicitis by implementation of a quality improvement (QI) initiative. MethodsOn December 1st, 2021, a QI initiative standardizing postoperative care for complicated appendicitis was implemented across a tertiary pediatric healthcare system with two main surgical centers. QI initiative focused on antibiotic and pain management. An extensive literature search was performed and a total of 20 articles matching our patient population were critically appraised to determine the best evidence-based interventions to implement. Antibiotic regimen included: IV or PO ceftriaxone/metronidazole immediately post-operatively and transition to PO amoxicillin-clavulanic acid for completion of 7-day total course at discharge. Discharge pain control regimen included acetaminophen, ibuprofen, as needed gabapentin, and no opioid prescription. Guideline compliance were closely monitored for the first six months following implementation. ResultsIn the first 6-months post-implementation, compliance with use of ceftriaxone/metronidazole as initial post-operative antibiotics was 75.6 %. Transition to PO amoxicillin-clavulanic acid prior to discharge increased from 13.7 % pre-implementation to 73.7 % 6-months post-implementation (p < 0.001). Compliance with a 7-day course of antibiotics within the first 6-months post-implementation was 60 % across both sites. After QI intervention, overall opioid prescribing remained at 0 % at one surgical site and decreased from 17.6 % to 0 % at the second surgical site over the study timeframe (p < 0.001). ConclusionAntibiotic use can be standardized and opioid prescribing minimized in children with complicated appendicitis using QI principles. Continued monitoring of the complicated appendicitis guideline is needed to assess for further progress in the standardization of post-operative care. Study TypeQuality improvement. Level of EvidenceLevel III.

Variations in Management of Zone 1 Open Globe Injuries Across Corneal Specialists.

The aim of this study was to describe variations in practice patterns for the management of zone 1 open globe injuries among corneal specialists worldwide. This cross-sectional study was performed using an online survey distributed to members of The Cornea Society. Responses were collected between September 9, 2021, and September 30, 2021. Of 94 responses included in analysis, respondents averaged 18.2 ± 14.5 years of postfellowship experience. Among respondents, 53 (56.4%) were affiliated with an academic institution and 41 (43.6%) with private practice. Ophthalmologists practicing in the United States were significantly more likely to use an eye shield preoperatively (98.5% vs. 85.7%, P = 0.03) and less likely to perform primary lensectomy in cases of lens involvement (40.9% vs. 75.0%, P = 0.002) compared with those practicing outside the United States. Ophthalmologists in practice fewer than 10 years were more likely to administer preoperative systemic antibiotics (91.4% vs. 66.1%, P = 0.006) and tetanus prophylaxis (88.6% vs. 67.8%, P = 0.03), and to obtain preoperative computed tomography scans (85.7% vs. 54.2%, P = 0.002) compared with more senior physicians. Ophthalmologists at academic institutions were more likely to perform preoperative B-scan (30.2% vs. 9.8%, P = 0.02), use general anesthesia (90.6% vs. 70.7%, P = 0.03), and admit for postoperative antibiotics (28.3% vs. 9.8%, P = 0.04), and were less likely to perform surgery overnight (45.3% vs. 70.7%, P = 0.02) compared with private practice physicians. There is significant variation in the practice patterns for the management of zone 1 open globe injuries among corneal specialists, which presents an opportunity to investigate whether certain treatment options lead to better outcomes in these injuries.

Hospital Mexico's preoperative antibiotic prophylaxis protocol for orthopedic patients: a compliance analysis

ObjectiveTo analyze compliance with a prescribed pre-surgical antibiotic prophylaxis protocol established by the Antimicrobial Stewardship Program team and the Orthopedics Department of Hospital Mexico, a public hospital located in Costa Rica, from February to March 2019. No assessments of compliance with the protocol had been conducted since its introduction in 2018, nor had variations in surgical site infection rates been determined. MethodThis is a retrospective observational study that extended from February 1st to March 31st, 2019. We identified patients hospitalized during the study period in the hospital's Orthopedics Department. We reviewed each patient's medical record to record their prescribed antibiotic prophylaxis. Following an analysis of the overall compliance with the protocol, we made an estimation of the surgical site infection rate as well as a descriptive analysis of the studied population. ResultsThe study included 110 clinical records. The most frequently prescribed antibiotics were clindamycin and gentamicin. Compliance with the protocol ranged between 89.1% and 100% across the different criteria, except for dosing appropriateness and prescription of antibiotics at discharge (14.3% and 65.8%, respectively). The most common non-compliance factor was gentamicin's dosing. The surgical site infection rate was 5%. ConclusionsThe preoperative antibiotic prophylaxis protocol established between the Antimicrobial Stewardship Program team and the Orthopedic Department reduced the length of exposure to postoperative antibiotics to only 24 hours and enjoyed widespread acceptance and a high compliance rate. However, compliance with some criteria must be improved, such as dosing appropriateness and prescription of antibiotics at discharge. Involvement of the pharmacist is vital for the compliance with and auditing of these types of protocols as pharmacists are uniquely positioned to ensure that high-quality antibiotic prophylaxis is provided in all surgical procedures that require it.

Prophylactic antibiotics in septoplasty with intranasal septal splints: A comparative analysis.

Postoperative antibiotic therapy is a common practice following septoplasty with intra-septal splints placement (ISS), even though there is a lack of evidence to support it. We sought to investigate the role of antibiotic therapy in septal surgeries with the placement of ISS. A retrospective comparative study was conducted using the electronic charts of adult patients who underwent septoplasty with the placement of ISS with or without turbinate reduction. Nasal cultures were taken routinely during surgery as part of the department's protocol for monitoring infectious diseases. The ISS were also routinely examined for the presence of bacteria after their removal on the eighth day following surgery. A large otolaryngology department in a tertiary medical center. Adult patients who underwent septoplasty in our institution. We analyzed all post-operative infections to search for risk factors in the cohort. Post-operative infection rates following septoplasty with ISS were low at 6%, which is consistent with previously published rates. Infection rates were significantly higher in patients who were not treated with antibiotics (OR = 8.2, 95%CI: 1.63-41.1; p = .01, φ = 0.04). Diabetes was associated with an increased risk of postoperative infection regardless of prophylactic antibiotic therapy (OR = 5.2, 95%CI: 1.15-23.5; p = .032, φ = .04). The detection of Klebsiella pneumonia before surgery was associated with an increased rate of postoperative infection (OR = 16.6, 95%CI: 3.02-91.54; p = .001, φ = 0.12). Patients undergoing septoplasty with the placement of ISS are at increased risk of gram-negative bacterial colonisation, and development of postoperative nasal infection. A single preoperative dose of IV antibiotic therapy should be considered a potential prophylactic option for septoplasty with ISS.

Surgical site infections: a cross-sectional study of bile culture

Background: Surgical site infections (SSIs) are one of the most common reported healthcare-associated infections worldwide. SSIs are also the most common complication of various surgical procedures, including cholecystectomy which is the standard surgical procedure for calculus cholecystitis. The association between SSIs and cholecystectomy is suspected due to infection from pathogens in the bile. This study aims to determine the relationship between bile culture results and the incidence of SSIs in patients with calculus cholecystitis undergoing cholecystectomy procedures. Methods: This study was an analytic observational study with a cross-sectional design which involved 44 subjects. The data obtained were then analyzed using the Chi square method with the IBM statistical package for the social sciences (SPSS) version 26. Results: There were 44 subjects with calculus cholecystitis included in this study. None of the subjects in this study had SSIs, and also 54.5% of the subjects were given postoperative antibiotics. The results of data analysis showed no significant association between bile culture and SSIs (p&gt;0.05). Additional analysis in this study also revealed no association between type of surgery and bile culture (p&gt;0.05) and between postoperative antibiotic administration and SSIs (p&gt;0.05). Conclusions: Positive bile culture was not associated with the incidence of SSIs in calculus cholecystitis patients undergoing cholecystectomy procedures. The findings of this study also revealed no association between type of surgery and SSIs and postoperative antibiotic administration is not a mandatory for every cholecystectomy procedure.

Factors Influencing Prevalence of Surgical Site Infections among Mothers Undergoing Ceaserean Section in Iganga Hospital, Uganda

Caesarean Section as a mode of delivery is the most commonly done surgical procedure in maternity departments all over the world. Surgical site infection complicates about one-third to two-thirds of caesarean sections in low-income countries which is about 9 times higher compared with the high-resource countries. Surgical Site Infection is associated with increased maternal morbidity, prolonged hospital stay and increased medical costs. The development of post-caesarean surgical site infection is hung on a complex interplay of many factors not limited to wound class, immune status, maternal age, hypertensive disorders, ASA classification, number of vaginal examinations, the virulence of the microorganisms, maternal weight, surgical techniques and premature rupture of membrane. The study employed a descriptive cross-sectional and quantitative approach to study the factors influencing the prevalence of surgical site infections among mothers undergoing caesarean section in Iganga Hospital. A sample size of 288 participants were enrolled using a random sampling technique and close-ended questionnaires were employed to obtain the data from participants. Data analysis was done using SPSS version 20 and statistical significance was set at a P-value less than 0.05 at 95% confidence interval. A total of 288 post-caesarean mothers were studied from October – November 2021 in Iganga Hospital. The majority of the participants were married 255(88.8%) and had a secondary level of education 142(49.3%). The mean age of the participants were 25.6 years with 21 as the modal age. The prevalence of surgical site infection among post-caesarean mothers at Iganga Hospital was 20.5% (59 out of 288) and the factors which were statistically influencing the SSI included early rupture of membranes of more than 18 hours (aOR 23.715 95% C.I 5.976-94.117, P 0000) and postoperative haemoglobin (aOR 15.109 95% C.I 3.494-65.333, P 0.000) There’s a high burden of SSI among post-caesarean mothers in Iganga Hospital. Earlyrupture of membranes more than 18 hours and post-operative haemoglobin less than 11g/dl are key contributory factors. Aggressive prophylactic and post-operative antibiotic therapy should be considered in mothers with early rupture of membranes and post-operative anaemia. Keywords: Caesarean Section, Maternal morbidity, Surgical Site Infection, Post-caesarean mothers, Vagina examination. IN

A survey of dental professionals' opinions around the use of antibiotics in molar 3 extractions and dental implant placement.

This survey was conducted to determine the type and frequency of antibiotics (AB) use for the prevention of infections in dental third molar (M3) extraction and implantation procedures (DIP) among UK dentists and the opinions underpinning their practice. Systematic reviews of the evidence were undertaken alongside this survey of practicing dentists in the United Kingdom to identify the opinions and practices of those undertaking the procedures.With ethical approval, a survey was designed for online delivery and was sent to every dental practitioner in the UK with a publicly available email address or social media contact. The opening page provided the project information sheet and proceeding to complete and submit the questionnaire was considered consent to participate. The online survey was circulated to 900 identified addresses and a total of 145 responses were received. Responses were collated in Microsoft® Excel™ and analyzed using IBM® SPSS™ plus thematic analysis of free text responses. There were 42% of participants (n=61) who discouraged AB prophylactic use in M3 extractions in people with no systemic conditions and who also preferred postoperative AB use when required. Where, 57.9% of respondents (n=84) supported the short-term use of ABs (5-7 days) for M3 extraction and 53% (n=77) in DIP placement in patients with no relevant medical history. As an ad hoc finding, dentists reported on the negative impact of heavy smoking and oral parafunctional behavior on DIP success. The use of antibiotics and broad spectrum antibiotics remains higher than current guidelines would recommend. Further research is required to clarify the specific risks arising from underlying medical conditions to further clarify where prophylaxis is required.

The diversity of hypospadias management in North America: a survey of pediatric urologists.

To determine trends in hypospadias management, including surgical techniques and perioperative care, by pediatric urologists in North America. An anonymous online survey was devised to assess approaches to hypospadias repair and management, including anesthetic considerations, catheter placement, choice of dressing, and postoperative antibiotic treatment. The survey was sent to all practicing members of the Societies for Pediatric Urology. The survey was completed by 133 (34.5%) respondents. Hypospadias repair was overwhelmingly recommended between ages 6-12months (89.5%). A local or regional anesthetic block (caudal, penile, pudendal, spinal) is performed nearly universally (96.2%). The majority of surgeons perform distal repairs outpatient (70.7%), while fewer perform outpatient staged repairs (47.4%) or redo surgery (33.8%). Nearly all respondents preferred either VicrylTM/DexonTM (50.4%) or MaxonTM/PDSTM (48.1%) for urethroplasty. All but one respondent leaves a stent for midshaft to proximal repairs whereas stenting for glanular repairs was split with 53.4% leaving a stent. Most surgeons (60.9-70.9%) prescribe postoperative antibiotics regardless of severity and the majority (72.9%) prescribe narcotics for analgesia. Approaches to hypospadias repair are extremely varied such that there is a lack of consensus among pediatric urologists regarding most aspects of hypospadias management. Investigations comparing hypospadias practice patterns are necessary to develop a standard of care for this complex pediatric urologic entity.

Complications Associated with Alloplastic Materials in Rhinoplasty and Their Operative Management.

Whereas rhinoplasty with a reduction of the dorsum and modification of the tip is a common procedure among Caucasians, augmentation of the dorsum remains a challenge in Asians. Choice of the ideal grafting material for dorsal augmentation is a matter of preference and remains under discussion. Autologous and alloplastic materials have their advantages and disadvantages. We report our experiences of the extrusion of alloplastic materials and their management. We report of 18 patients, who had rhinoplasty in the past for dorsal augmentation with alloplastic material. Augmentation rhinoplasty was performed in Asia (n = 15) and Germany (n = 3). All cases showed recurrent signs of foreign body infection and/or partial extrusion and therefore underwent revision surgery in our centers. Once all patients had been successfully treated with antibiotics, we performed a one-stage revision rhinoplasty with explantation of the alloplastic material and subsequent reconstruction with autologous rib cartilage. The nasal dorsum was augmented with either solid rib cartilage grafts, diced cartilage in fascia, or free diced cartilage in platelet-rich fibrin. All patients received pre-, peri-, and postoperative antibiotics. The outcome was screened via clinical examination, ultrasound examination pre- and postoperatively, two-dimensional/three-dimensional (3D) imaging, and magnetic resonance imaging scans.Alloplastic augmentation of the nasal dorsum runs the risk of foreign body reaction, recurrent infections, uncontrolled scarring, and unsatisfying long-term results. We have obtained a series of aesthetically and functionally satisfying results after single-stage revision surgery with autologous cartilage and demonstrate a variety of novel postoperative screening tools including 3D imaging and high-frequency ultrasound. LEVEL OF EVIDENCE: N/A.

Intravenous antibiotic therapy after laparoscopic appendectomy in acute complicated appendicitis: the patient clinical response is the key.

The guidelines about acute complicated appendicitis (ACA) recommend 3-5 days of postoperative intravenous antibiotics (IVA). Nevertheless, the time selected by the surgeon can vary according to patient clinical response, ACA type, and professional experience. Once an adequate clinical response is obtained, the change from IVA to oral antibiotic (OA) could be realized without the waiting time established with satisfactory results. Determine if a short course of IVA and/or switch to oral route is safe based on the patient clinical response. Observational prospective cohort study from a general surgery reference center database since July 2019. 48 patients with ACA intraoperative findings were included. Regarding postoperative antibiotic management, only preoperative IVA: 7 (14.58%), IVA 1-3 days: 1 (20.83%), IVA 1-3 days and change to OA: 21 (43.75%), IVA > 3 days: 6 (12.5%), and only OA: 3 (27.08%). The bivariate analysis did not show statistically significant differences in reconsultation (p = 0.81), rehospitalization (p = 0.44), and surgical site infection (p = 0.56) between the antibiotic scheme based on the postoperative clinical response and the traditional one regarding intra-abdominal collection rate, the hospital stays, and hospitalization costs.

Transcutaneous compression suture with iodine gauze for wound closure in revision surgery for therapy-resistant periprosthetic shoulder infections

To successfully treat a periprosthetic infection, successful bacteria eradication and successful wound closure are mandatory. Despite adequate surgical débridement in the deep, persistence of wound drainage and subsequent persistence of periprosthetic infection may occur, especially in patients with compromised soft tissue conditions. This study presents a transcutaneous compression suture technique with iodine gauze that was used in patients with persistent wound secretion in therapy-resistant periprosthetic shoulder infections in order to achieve successful infection control and wound healing. All patients with persistent periprosthetic or implant-associated shoulder joint infections despite correct previous surgical and antibiotic therapy attempts were included in the study. In all patients, in addition to repeat deep surgical débridement, a transcutaneous "iodine-gauze-compression-suture" was performed with postoperative antibiotic therapy. The primary endpoint was infection control; the secondary endpoint was wound healing rate; and the third endpoint was complication rate after index surgery. Ten consecutive patients with a mean age of 74 (±7.6) years and a mean follow-up of 14 (±2) months were included. All ten patients showed infection control and successful wound healing, with no need for further revision surgery. In 8 out of 10 patients, the wound healing was fast and completely uncomplicated. Two out of 10 patients showed delayed wound healing with fibrin coatings for 3 and 4 weeks, respectively. No additional intervention was necessary in both patients. Transcutaneous iodine gauze compression sutures were used to achieve successful infection control without additional revision surgery in 10 out of 10 patients who previously underwent surgery with failed infection control. This wound closure technique is a reliable adjunctive therapy method in the treatment of implant-associated infections of the shoulder in patients with fragile wound conditions.

493 Audit of Antibiotic Prescriptions in Appendicectomies and Adherence of Surgeons to National and Local Trust Guidelines: Preoperative and Postoperative

Abstract Aim To investigate adherence of antibiotic prescriptions to national and local standards in appendicectomies, pre-operative &amp; post operative, in a district general hospital. BMJ Best Practice standards state that all patients should be given prophylactic antibiotics preoperatively, but only complicated cases (perforation and/or abscess and/or acutely unwell) need to be given postoperative antibiotics. Adherence to local prophylactic antibiotic guidelines was also assessed. Trust antimicrobial guidelines are freely available on the MicroGuide mobile application - https://tinyurl.com/gastrosurg. Method A retrospective audit conducted in a district general hospital. A 6-month audit of antibiotic prescriptions in appendicectomies to investigate adherence rate to national and local standards. The important information was collected from the trust’s electronic patient record through a predesigned Pro forma. Results A total of fifty patients (patients with penicillin allergy; n = 4; 8%) underwent an appendectomy between June 2022 and November 2022 in a district general hospital. 100% of patients were given prophylactic antibiotics. However, only 25% of cases of penicillin allergy and 2.2% of cases with no penicillin allergy were given prophylactic antibiotics that adherent to trust policy. Complicated cases comprised 30% of cases. 100% of complicated cases had postoperative antibiotics while 80% of uncomplicated cases had postoperative antibiotics unnecessarily. Conclusions This audit cycle showed poor adherence to national and local antimicrobial standards. Action plan includes presenting results in the monthly surgical audit meeting, increase awareness of the MicroGuide app and BMJ Best Practice standards and reaudit to enhance adherence to antimicrobial guidelines.

1239 Microbiology, Culture and Sensitivity Analysis During Drainage of Non-Perianal Soft-Tissue Abscesses: Do We Review the Results and How Often Do They Change Management?

Abstract Aim The utility in obtaining microbiology, culture, and sensitivity (MC&amp;S) specimens during drainage of soft-tissue abscesses is controversial. This study aimed to determine if routine MC&amp;S analysis changed management after drainage of non-perianal abscesses. Method A retrospective review was undertaken of consecutive patients undergoing drainage for non-perianal superficial abscesses between July and November 2021. Data recorded included whether an MC&amp;S specimen was taken, the result, any antimicrobial treatment and clinical outcome. Using the Auditing functions inbuilt to the software, whether the surgical team had subsequently reviewed the result was also determined. Results 76 patients underwent abscess drainage, located in the pilonidal region (32%), axillary (24%), buttock (24%), groin (11%), neck (5%) and trunk (5%). MC&amp;S was sent from 52 cases (69%). Results were reviewed by the surgical team in 6 cases (11%). Samples were positive in 34 cases (65%). Mixed organisms were the most common positive finding (28 cases) and sensitivity was not performed on these samples. Methicillin-sensitive S aureus was cultured from 4 cases (8%), Methicillin-resistant S aureus from 1 case (2%) and Staphylococcus lugdenensis from 1 case (2%). Post-operative antibiotics were prescribed for 25 patients. 4 patients required a further course of antibiotics postoperatively and in all these cases MC&amp;S was taken but showed no growth. Conclusions Few MC&amp;S results were reviewed by the surgical team and MC&amp;S results did not guide management in any case. These results support the hypothesis that routine MC&amp;S sampling is not required for typical abscesses in low-risk patients.

1009 Improving Accuracy and Extractability of Electronic Operative Documentation Data in a Hand Trauma Unit

Abstract Aim Accurate and thorough operative documentation is essential for continuity of patient care, audit purposes, and the medicolegal protection of patients and doctors. In a hand trauma department in central London, challenges to this include a fast turnover of junior doctors, busy trauma lists, and complex, multidisciplinary cases. ‘Pathpoint’ is an online system with functionality for operative note templates and pre-filled data. However, it is unclear how much this is utilised in the department. This project aimed to evaluate operative documentation for hand trauma and the utilisation of templates for data input. Method All hand trauma cases performed in a one-month period were requested from Pathpoint. Operation notes were initially screened for directly extractable data in template-form then manually checked for free-text data entry using prior-agreed criteria. Results The initial search yielded 51 procedures. Nerve repairs were best documented (18% data missing), terminalisation procedures were worst documented (38% data missing). Overall, only 18.3% of all data were directly extractable; 0% data were extractable for dressings, post-operative antibiotics, follow-up and movement restrictions. Best documented topics were hand trauma findings, skin closure, and follow-up. &amp;gt;90% of data in each of these were freetext. Worst documented topics were CEPOD category, ASA grade, intra-operative antibiotics, and tourniquet details. Conclusions Despite overall good documentation, multiple important omissions are noted. Furthermore, the majority of data is not recorded in an extractable format. Templates have been distributed within the department. Re-auditing in subsequent months will assess whether accuracy of documentation and ease of data extraction have improved.

External Negative Pressure Dressing System (ENPDS) vs. Traditional Wound Dressing for Cesarean Section Incision in Obese Women: A Randomized Controlled Trial

Background Obesity is associated with increased cesarean section delivery rates and surgical site wound complication with associated increased post-operative morbidity, post-operative pain and length of hospital stay. Aim of the Work The objective of this study is to determine whether negative pressure wound therapy reduces the risk of post-cesarean wound dehiscence among obese women compared with standard surgical wound care. Patients and Methods A Randomized controlled trial (RCT)was carried out at Ain-Shams University Maternity Hospital in the period between August 2020 and February 2021. The participants of this study were 260 pregnant women aged 18 years old or older who underwent cesarean delivery. Intervention group had an ENPDS placed for 4 days and control group had a traditional surgical dressing placed for 4 days and both group were followed up for 30 days post-operatively. Results The study reveal that wound dehiscence was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.002). The study also reveal and display that SSI was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.017). After adjustment for the effect of BMI and history of CS, PA surgery or SSI, ENPDS was independently associated with reduced incidence of SSI (odds ratio = 0.262, 95% CI = 0.090 to 0.759, P-value = 0.014). The study reveal that the incidence of wound dehiscence and SSI is statistically significantly lower in ENDPS group compared with traditional dressing group (p value =0.004, 0.012,) respectively. The incidence of wound seroma and haematoma was lower in ENDPS group however, not statistically significant compared with traditional dressing group (p value= 0.066, 0.498) respectively.The study reveals that using ENDPS has a beneficial/ protective effect as regards wound dehiscence and SSI with relative risk (0.25, 0.31) respectively with 95% CI (0.1 TO 0.65 - 0.12 TO 0.83) respectively and NNT (8.7, 11.8) respectively with 95% CI (5.4 to 22.2. - 6.7 to 52.2) respectively.It also shows that ENDPS has a beneficial /protective effect as regards wound seroma and wound hematoma formation with relative risk (0.14, 0.20) respectively even though the 95% CI was (0.02 to 0.14 - 0.01 to 4.13) respectively and the NNT was (21.7, 65.5) respectively. The study reveals that peri-wound blistering, the need for post-operative therapeutic anti-biotics and re-admission was statistically significantly lower in ENDPS group compared to the traditional dressing group (p value= 0.001, 0.005, 0.010) respectively. The study reveals that post-operative pain was less in ENDPS group with p value = &amp;lt;0.001, post-operative mobility was more limited in ENDPS group when compared with the traditional dressing group with p value = &amp;lt;0.001. However, the length of hospital stay was statistically significantly longer in ENDPS group with p value = &amp;lt;0.001 Conclusions Negative pressure wound therapy could be used to reduce the risk of wound dehiscence, surgical site infection, wound seroma, wound haematoma, peri-wound blistering, post-operative pain, post-operative anti-biotics and overall length of hospital stay for obese women undergoing cesarean delivery.

520 The role of abdominal drains in Laparoscopic Appendicectomy: a prospective study of 260 patients

Abstract Aims Guidance regarding the use of antibiotics and drains following laparoscopic appendicectomy remains unclear. We aim to describe current practice at our unit with the view to forming a local guideline. Method A prospective review of all adult patients undergoing laparoscopic appendicectomy at our unit between July 2021-July 2022 was performed. Data was collected from electronic patient records and theatre software, including patient demographics, blood and imaging results and drain and antibiotic details where applicable. Results 260 patients underwent laparoscopic appendicectomy (53.1% female) with a median age of 38 years (IQR 30.75). 87.7% were positive for appendicitis on histology.11.2% were discharged within 23 hours from admission. The median length of stay was 2 days (IQR 2). 70.7% received postoperative antibiotics with a median duration of 5 days. 25.4% had a drain inserted and had a significantly longer inpatient stay (3 vs 2 days, p&amp;lt;0.001). Those with drains had a higher median CRP compared to those who did not (137 vs 38, p=&amp;lt;0.001) and this association remained significant on multivariate analysis when controlling for white blood cell count and lactate (p&amp;lt;0.001). Patients who had post-operative antibiotics or a drain were not more likely to re-present following discharge (p=0.586 and p=0.169 respectively). Conclusions In our cohort drains did not reduce likelihood of complications but increased length of time in hospital. Further research is needed to identify specific patients, if any, who would benefit from drain use.

FTP7.14 A systematic review and meta-analysis evaluating the role of single-dose preoperative versus extended use of antibiotics therapy following acute cholecystectomy

Abstract Laparoscopic cholecystectomy (LC) during index admission for acute cholecystitis is considered a preferred mode of treating gallstone disease. The objective of this study is to evaluate the role of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days in these patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis. Materials and methods RCTs reporting the use of single dose pre-operative prophylactic antibiotics versus extended antibiotics therapy up to 5th post-operative days following acute cholecystectomy were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5. Results The search of medical databases yielded 4 RCTs on 949 patients undergoing acute cholecystectomy. There were 481 patients in in single dose pre-operative antibiotics group whereas 468 patients received extended doses antibiotics therapy. In the random effects model analysis, the extended use of post-operative antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not confer any extra benefit [risk ratio 1.05, 95%, CI (0.73, 1.51), Z = 0.25, P=0.80] in terms of reducing the infective complications. There was no heterogeneity (Tau2 = 0; Chi2 = 0.40, df = 3; (P = 0.94; I2 = 0 %) among included studies. Conclusion Post-operative extended use of antibiotics in patients undergoing acute cholecystectomy for mild to moderate acute cholecystitis does not demonstrate extra benefit to reduce infective complications.

Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers.

Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed. ALO were introduced within our routine Orthopaedic MDT on the 22nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay. Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040). Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

Topical streptomycin irrigation of lesions to prevent postoperative site infections in spinal tuberculosis: a retrospective analysis

PurposeIn spinal tuberculosis surgery, topical administration of drugs to the lesion is a preventive treatment measure. The aim is to achieve better bacterial inhibition and to prevent complications. As one of the most common complications after spinal tuberculosis surgery, many factors can lead to surgical site infection (SSI). No definitive reports of local streptomycin irrigation of the lesion and SSI of spinal tuberculosis have been seen. This study analyzed data related to surgical site infections (SSI) after the treatment of spinal tuberculosis using this regimen.MethodsIn this study, 31 were in the observation group (streptomycin flush) and 34 in the control group (no streptomycin flush). All patients received the same standard of perioperative care procedures. General information, operative time, intraoperative bleeding, ESR and CRP at one week postoperatively, time on antibiotics, total drainage, days in hospital, incision infection rate and secondary debridement rate were compared between the two groups.ResultsPatients in both groups completed the surgery successfully. The ESR and CRP levels in the observation group were lower than those in the control group one week after surgery (p < 0.05); the duration of postoperative antibiotics and hospital stay were lower than those in the control group (p < 0.05); the incidence of SSI in the two groups was 5.88% and 6.45% respectively, with no significant difference (p > 0.05).ConclusionThe use of topical streptomycin irrigation of the lesion during surgical procedures for spinal tuberculosis had no significant effect on the incidence of SSI, however, it helped to control the level of infection in the postoperative period and reduced the length of time patients had to use postoperative antibiotics and the number of days they stayed in hospital. Future prospective randomised controlled trials in more centres and larger samples are recommended.