Wound Sepsis Research Articles

Profiles of patients with myelomeningocele admitted to the neonatal unit at Universitas Academic Hospital in Bloemfontein, South Africa


 
 
 
 Background. Myelomeningocele (MMC) is a common neural tube defect with significant sequelae. There are limited recent data on the mortality and morbidity of MMC in South Africa (SA).
 Objective. To describe the outcomes and characteristics of patients with MMC admitted to the neonatal unit at Universitas Academic Hospital (UAH) in Bloemfontein, SA.
 Methods. A retrospective, descriptive study which included 53 patients with MMC admitted to the neonatal unit between 1 January 2017 and 31 December 2019 was conducted. Electronic patient records were reviewed. Data included outcomes, length of stay, complications and maternal and infant characteristics.
 Results. The inpatient mortality rate was 11.3% (n=6/53). The median length of stay was 18 days. Notable MMC complications included hydrocephalus (88.7%; n=47/53), Chiari malformation type II (44.7%; n=21/47), lower-limb paralysis (84.9%; n=45/53), lower-limb deformities (60.4%; n=32/53), meningitis (52.8%; n=28/53), neuropathic bladder (37.7%; n=20/53) and loss of anal tone (41.5%; n=22/53). MMC repair was performed in 62.2% (n=33/53) and 27.3% (n=9/33) developed complications. Wound sepsis and breakdown were the most common complications (18.2%, n=6/33), with a median 8 days to complications. Antenatal sonar was not performed in 62% (n=31/50) of cases. MMC was detected antenatally in 20% of cases.
 Conclusion. The inpatient mortality rate in thisstudy was lower than the mortality rates reported in other low- and middle-income countries although significant morbidity was identified. A lack of quality antenatal care and access to antenatal sonars were barriers to early detection of MMC. Other healthcare system infrastructural failures may be contributory, which highlights the need for ongoing inter- sectoral collaboration for prevention, early detection and management of MMC to improve patient outcomes.
 
 
 

Temporary Stomas after Rectal Cancer Resection; Predilection of Being Permanent and Predictors of Complications?

AbstractStomas are essential for colorectal surgery and are widely used not only for selected cases for bowel obstructions but also in rectal cancer operations to divert stool away from low rectal anastomosis. On the other hand, complications with stomas/ stomas reversal are not uncommon. In this study, we aimed at studying the frequency and the predictors of temporary stomas being permanent, and the contributing factors of surgical stoma/stoma closure related complications. In our cohort, only about 40% of the patient closed their initially planned temporary stomas. The occurrence of intestinal leak, wound sepsis, or any type of morbidity with 30 days of operation were significant predictors of permanent stomas. In addition, alarmingly although Hartmann's procedure was uncommon in our practice, only 9% of those who underwent Hartmann's have had it reversed. Moreover, the only factor that significantly increased stoma related complications was having an end colostomy. There was a tendency toward late closure of stomas with median 8.2 months, however early closure did not correlate to complications. In conclusion, further studies are needed to delineate the low rate of stoma closure. Patients who develop postoperative complications, even wound sepsis, would be at a higher risk of living with permanent stomas. Hartmann's procedures are commonly associated with stoma problems, and reluctance to reverse the stomas.

5-year review of hysterectomy at the Delta State University Teaching Hospital, Oghara, south-south Nigeria

Context: Hysterectomy is a major surgical procedure that is performed worldwide for several indications ranging from benign to malignant conditions. It may be life-saving especially in certain obstetric situations.
 Objective: The aim was to determine the incidence, indications and complications of hysterectomy in Delta State University Teaching Hospital (DELSUTH), Oghara.
 Materials and methods: This was a retrospective descriptive study of hysterectomy performed in DELSUTH, Oghara from January 1st, 2012 to December 31st 2016. Every patient that had hysterectomy was included.
 Results: During the period, there were there 468 major gynaecological surgeries. Eighty-five patients had hysterectomy accounting for 18.2%. The mean age of the patients was 47.9±10.6 years. Majority (46.6%) of the patients were para 5 and above. The mean parity was 3.2±0.83. Uterine fibroid accounted for majority (30.0%) of the cases. Total abdominal hysterectomy accounted for 78.75% while 8.75% had sub-total abdominal hysterectomy and 12.5% had vaginal hysterectomy. Fifty-two percent of the patients had bilateral salpingo-oophorectomy while 6.25% had unilateral salpingo-oophorectomy. Anaemia and wound sepsis were the most common complications. One patient (1.25%) ended as a mortality during the period under review.
 Conclusion: The indications for, and surgical outcome following hysterectomy are comparable to that from other public hospitals across the country.

USEFULNESS OF PROCALCITONIN AS A BIOMARKER IN BURN PATIENTS PLASTIC SURGERYDEPARTMENT, MOHAMMED VI UNIVERSITYHOSPITAL, MARRAKECH, MOROCCO

Infection is the most common complication and cause of death in patients suffering burnsinjuries.These patients are susceptible to infection and burn wound sepsis secondary to the alterations in their physiology .Procalcitonin is an inflammatory biomarkers , the serum concentration of which increases specifically during bacterial infections. For a burn patient, its sometimes difficult to differentiate, on the basis of the clinical examination , those who suffer from an acute inflammatory syndrome from those who show the first signs of a severe bacterial infection. However, a correct diagnosis is essential for the prompt initiation of appropriate treatment . Many markers associated with an infectious state have recently been investigated. Among them , serum pro calcitonin has the best sensitivity and specificity for sepsis or other severe bacterial infections. The aim of this work is to evaluate the impact of the implementation of procalcitonin (PCT) on the management of infected patients in the burns resuscitation department of the plastic surgery department at CHU Med VI.Our study is retrospective , observational, and conducted over a period of 6 months, extending from July 1, 2022, to December 31, 2022, for 24burned patients hospitalized in the intensive care unit of the plastic surgery department .The average age of the patients was 38 years they were predominantly male with a sex ratio of about 1.5 . The average burned skin surface was 27.75% 40.3% had a deepening with signsof skin infection all patients CRP was high 60% had a fever higher than 38.5 13.3% had a stay in the surgical resuscitation department and were discharged a PCT returned positive in 16.6% of patientsthe determination was repeated in 4 patients after 24h returned Negatif 26.6% had a positive bacteriological examination and 40% of patients received antibiotic therapy .PCT maybe used as a useful bio marker for the early diagnosis of burn sepsis in adults, and maybe combined with other diagnostic indexes to further improve the sensitivity and specificity. Thus, even throughout study provides us with the knowledge that the PCT maybe a helpful sepsis biomarker in burned patients, the findings should be viewd with caution.

The impact of colon injuries on the outcome of gunshot wounds to the abdomen

PurposeFactors predicting morbidity and mortality in patients with colon-related gunshot injuries and the management of these injuries are not always straightforward. This aimed to assess the impact of abdominal gunshot wounds with colonic injuries on patients’ overall outcomes.MethodsThis cross-sectional prospective observational study compared patients with colon injuries and without colon injuries. Data was collected from admission, theatre and postoperative care. Patients were recruited between 1 January 2020 and 20 October 2021.ResultsOf 132 patients with abdominal gunshot injuries, 71 (54.0%) had colon injuries. The colon injury group had a higher incidence of laparotomy wound sepsis (p<0.0001), bullet exit wound infection (p<0.0001), tract necrotizing fasciitis (p<0.0001), relook laparotomies (p<0.0001) and a longer hospital stay (p<0.0001). Septicaemia (p=0.002) or anastomotic leak (p=0.041) was associated with a penetrating abdominal trauma index (PATI) ≥25. Most patients who developed tract necrotizing fasciitis did not have their tract debrided/ lavaged (p=0.004). The type of colon repair did not influence the length of hospital stay (p=0.688) or the development of a colon-related complication (p=0.578). Between 18 and 25 years (p<0.0001) and >2 organs injured (p=0.018) were associated with colon-related complications. Patients between 18 and 25 years were 4.748 times more likely to develop a colon-related complication (p=0.046).ConclusionGunshot wounds to the abdomen with associated colonic injuries had a worse outcome with an increased risk of developing wound infections. There is no difference in the operative management of colonic injury. Patients between the ages of 18 and 25 years or >2 organs injured are more likely to develop a complication.

WTP5.5 A 6 year Review of Pilonidal Operations in a DGH

Abstract Aims Pilonidal Disease can be difficult to manage and operative management carries well known risk. We aimed to review all pilonidal operations from a 6 year period in our DGH, especially complications and reoperations. Methods An excel database was created and hospital coding data pulled for any pilonidal operation including elective and emergency over a 6 year period from 2015-2020. Hospital electronic and paper notes were used to cross reference coding data with op notes and discharge paperwork. Complications were then categorised as “Major” or “Minor” and type of complication documented. Number of reoperations was counted. Results 183 operations were carried out on 151 individual patients (103 male and 48 female). There were 33 reoperations on 21 patients. 78 formal elective operations were done with 68 primary closure and 10 laid open. Of primary closure there were only 13 complications – 5 major and 8 minor. Major complications included return to theatre for wound dehiscence, and wound sepsis. Those with major complications mainly had pre-existing complicated disease and all had previous emergency I&amp;D. All patients who had primary closure had ongoing symptomatic disease prior to operation with 29 having previous emergency I&amp;D. Conclusions Most patients with ongoing symptomatic disease benefit from definitive management in the form of elective primary closure eg Bascom procedure. Despite the well recognised risks of this surgery, most complications are minor and major complications are often reflective of a history of problematic pilonidal disease.

The effect of allergies on outcomes following shoulder arthroplasty: A national database analysis of 154,478 patients

Background The objective of this study is to investigate the effect of allergies on complications following total shoulder arthroplasty (TSA). Materials and Methods All data were collected by using the PearlDiver national database to identify patients who had undergone TSA (anatomic or reverse) between 1 January 2010 and 31 October 2021. Patients were stratified into two groups: allergies and no allergies. Comparisons were made regarding complications and revision surgeries. Complications were compared at 30 and 90 days. Revisions were compared at 1, 5 and 10 years postoperatively. Results This study identified 28,182 patients with allergies and 126,296 patients without allergies. Patients with allergies were more likely to require revision surgery at all time points analyzed (p &lt; 0.001). Patients with allergies were more likely to have sepsis within 30 (OR 1.53 [1.30–1.80], p &lt; 0.001) and 90 days (1.71 [1.51–1.94], p &lt; 0.001) postoperatively. Patients with allergies were more likely to experience a wound complication within 30 (1.89 [1.58–2.26], p &lt; 0.001) and 90 days (1.81 [1.58–2.08], p &lt; 0.001). The allergy group experienced higher rates of prosthetic joint infections (PJI) (2.14 [1.81–2.54], p &lt; 0.001) and implant complications at 90 days (1.52 [1.42–1.62], p &lt; 0.001). Discussion Patients with allergies were more likely to require revision surgery, experience wound complications, sepsis and PJI following TSA.

Preoperative vaginal cleansing with chlorhexidine and cetrimide solution for reduction of postoperative infectious morbidity at a tertiary care center in North India: A prospective cohort study.

To determine the effect of preoperative vaginal cleansing with chlorhexidine and cetrimide solution on postoperative infectious morbidity. This prospective cohort study was conducted over a period of 18 months in the Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Women undergoing cesarean section were alternately allotted to study and control groups. Women with chorioamnionitis, antepartum hemorrhage, rupture of membranes for more than 24 h, and fever in the preoperative period were excluded. The study group received preoperative vaginal cleansing with antiseptic solution (7.5% chlorhexidine w/v and 15% cetrimide w/v); the control group did not receive vaginal cleansing. Both groups were followed for the presence of any infectious morbidity until they were discharged from the hospital. Age, body mass index (calculated as weight in kilograms divided by the square of height in meters), gestational age, and the parity of the women in the study and control groups were comparable (n = 760). The rate of endometritis was lower in the study group, but the difference was not statistically significant (P = 0.054). Post-cesarean febrile morbidity and wound sepsis were significantly lower in the study group (P = 0.017 and P = 0.02, respectively). On subgroup analysis, women in the study group with rupture of the membranes before cesarean delivery had lower wound sepsis and a reduced duration of hospital stay. Women in the study group with emergency cesarean delivery showed a significant reduction in wound sepsis, febrile morbidity, and length of hospital stay. Preoperative vaginal cleansing with chlorhexidine and cetrimide solution before a cesarean section reduces postoperative infectious morbidity.

Jet Lavage Irrigation Resolves Stage 4 Pelvic Pressure Injury Undermining.

Patients with stage 4 pelvic pressure injuries that have large, undermined cavities are at high risk for treatment failure and often fall into the category of palliative care. This case series identified five cases where treatment had stalled, and surgical reconstructive options were limited. Jet lavage irrigation in the outpatient setting was assessed as a treatment alternative. From an investigational review board study assessing the use of low-pressure jet lavage irrigation in the outpatient setting for chronic wounds, five patients were identified where the wound dimension increased at least 50% resulting from undermined cavities. All were considered high risk with Charlson Comorbidity Index scores of 5 or greater, and their wound healing had stalled with extended treatments of topicals and medicated dressings. A team of physical therapists irrigated these patients' wounds at the bedside with 3 L of saline 3 to 5 days per week using a special long irrigation tip to reach the depth of the undermined cavity. Digital planimetry was used to assess healing with wound size as the outcome. Reduction of the undermined cavities was seen early within the first 3 weeks. No patient developed wound sepsis, and bacterial contamination was determined by use of autofluorescence digital imaging. Undermining resolution occurred in four patients, and one patient with an improving wound died of COVID-19. This simple method offered clear benefits in each patient, but only one patient survived to complete wound healing. Patient and family satisfaction were high regarding the treatment, which created a painless, odor-free wound.

Skewing cPLA2α activity toward oxoeicosanoid production promotes neutrophil N2 polarization, wound healing, and the response to sepsis.

Uncontrolled inflammation is linked to poor outcomes in sepsis and wound healing, both of which proceed through distinct inflammatory and resolution phases. Eicosanoids are a class of bioactive lipids that recruit neutrophils and other innate immune cells. The interaction of ceramide 1-phosphate (C1P) with the eicosanoid biosynthetic enzyme cytosolic phospholipase A2 (cPLA2) reduces the production of a subtype of eicosanoids called oxoeicosanoids. We investigated the effect of shifting the balance in eicosanoid biosynthesis on neutrophil polarization and function. Knockin mice expressing a cPLA2 mutant lacking the C1P binding site (cPLA2αKI/KI mice) showed enhanced and sustained neutrophil infiltration into wounds and the peritoneum during the inflammatory phase of wound healing and sepsis, respectively. The mice exhibited improved wound healing and reduced susceptibility to sepsis, which was associated with an increase in anti-inflammatory N2-type neutrophils demonstrating proresolution behaviors and a decrease in proinflammatory N1-type neutrophils. The N2 polarization of cPLA2αKI/KI neutrophils resulted from increased oxoeicosanoid biosynthesis and autocrine signaling through the oxoeicosanoid receptor OXER1 and partially depended on OXER1-dependent inhibition of the pentose phosphate pathway (PPP). Thus, C1P binding to cPLA2α suppresses neutrophil N2 polarization, thereby impairing wound healing and the response to sepsis.

Prophylactic Antibiotic Duration and Infectious Complications in Pancreatoduodenectomy Patients With Biliary Stents: Opportunity for De-escalation.

The aim of this study was to compare infectious complications in pancreatoduodenectomy (PD) patients with biliary stents treated with short, medium, or long durations of prophylactic antibiotics. Pre-existing biliary stents have historically been associated with higher infection risk after PD. Patients are administered prophylactic antibiotics, but the optimal duration remains unknown. This single-institution retrospective cohort study included consecutive PD patients from October 2016 to April 2022. Antibiotics were continued past the operative dose per surgeon discretion. Infection rates were compared by short (≤24h), medium (>24 but ≤96h), and long (>96h) duration antibiotics. Multivariable regression analysis was performed to evaluate associations with a primary composite outcome of wound infection, organ-space infection, sepsis, or cholangitis. Among 542 PD patients, 310 patients (57%) had biliary stents. The composite outcome occurred in 28% (34/122) short, 25% (27/108) medium, and 29% (23/80) long-duration ( P =0.824) antibiotic patients. There were no differences in other infection rates or mortality. On multivariable analysis, antibiotic duration was not associated with infection rate. Only postoperative pancreatic fistula (odds ratio 33.1, P <0.001) and male sex (odds ratio 1.9, P =0.028) were associated with the composite outcome. Among 310 PD patients with biliary stents, long-duration prophylactic antibiotics were associated with similar composite infection rates to short and medium durations but were used almost twice as often in high-risk patients. These findings may represent an opportunity to de-escalate antibiotic coverage and promote risk-stratified antibiotic stewardship in stented patients by aligning antibiotic duration with risk-stratified pancreatectomy clinical pathways.

Neonatal Giant and Open Neural Tube Defects: Challenges and Lesions Learnt

Abstract Background: Management of large/open neural tube defects (NTDs) is challenging and outcome is demanding. Aims: To analyze the outcomes in giant NTDs. Materials and Methods: The data between June 2017 and September 2022 were analyzed. Those with incomplete data, not giving consent or lost to follow-up, were excluded. All underwent closure using primary closure, Z plasty, or rhomboid flap. Dura closure was achieved with native dura augmented with thoracolumber fascia. The outcome was analyzed with respect to duration of surgery, blood loss, requirement of Z plasty for closure, wound infection, blackening of the flaps, cerebrospinal fluid leak, and features of sepsis. Result: 164 out of 243 cases formed the study group. Mean age at presentation was 4 days (range 0–28 days). Mean duration of surgery was 2 days (range 1–3 days). Mean operating time was 1.15 hours (range 0.45–3.15 hours). Hydrocephalous was present in 146 cases and all required ventriculo peritoneal shunt. Lower limb paraplegia and spasticity were present in 63 and 23 cases. Skin closure was achieved by primary closure in 23, double Z plasty in 76, and rhomboid flap in 65 cases. Wound infection and blackening of flap were seen in 13 and 1 case in double Z plasty and 6 and 7 cases in rhomboid flap group, respectively (P = 0.7). cerebrospinal fluid leak was seen in 8 cases. Wound dehiscence and sepsis were seen in 10 and 28 cases, respectively. Conclusion: Management of large defect requires adequate planning. cerebrospinal fluid shunting and flap/Z plasty are often required.

764 Comparison of Topical Silver Sulfadiazine and Triple Antibiotic Ointment in a Porcine PT Burn Model

Abstract Introduction The standard of care for partial thickness burns is topical antibiotics or occlusive dressing. Silver Sulfadiazine (SSD) emerged at a time of burn wound infection and sepsis prevalence and is now the most used topical worldwide. Despite its antimicrobial benefits, SSD has been shown to inhibit keratinocytes and there is concern that it might delay wound healing. This study compared time to complete wound closure and reepithelialization in partial thickness porcine burns treated with SSD, triple antibiotics ointment or petrolatum ointment Methods We created 21 deep partial thickness (DPT) burns per animal on the backs and flanks of 3 anesthetized domesticated pigs (30-35 kg) using an established vertical progression model (aluminum bar preheated to 80° C for 20s). In each pig, burns were randomly assigned SSD, triple antibiotic ointment, or petrolatum ointment (in a 1:1:1 ratio) applied daily for two weeks followed by twice weekly for another 2 weeks. Healing progression was measured by wound digital photography and punch biopsies to assess gross wound closure, reepithelization and scar depth respectively. Results The median (IQR) days to complete wound closure were 17 (17-21), 17 (14-21), and 21 (17-21) for wounds treated with SSD, petrolatum and triple antibiotic ointment respectively (p=0.06). The mean percentage of wound reepithelization at days 10, 14, 17, 21, and 28 for wounds treated with, SSD, petrolatum, and triple antibiotic ointment were 10%±20 vs. 8%±14 vs. 3%±12 (p=0.34), 45%±49 vs. 37%±44 vs. 48%±42 (p=0.74), 82%±38 vs. 86%±20 vs. 90%±27 (p=0.7), 74%±38 vs. 65%±50 vs. 93%±16 (p=0.049), and 92%±17 vs. 91%±28 vs. 98%±5 (p=0.4). The mean scar depth was 3.9 (1.1), 4.2 (0.9), and 3.4 (0.9) mm for wounds treated with SSD, petrolatum, and triple antibiotic ointment respectively (p=0.07). RMANOVA analysis showed significant change over time (p&amp;lt; 0.001) and a near significant difference between groups (p=0.054). On macroscopic analysis, appreciable pseudoeschar formation and erythematous allergic reactions were identified on wounds treated with SSD and triple antibiotic ointment respectively. Conclusions No significant differences in wound healing were found between groups in this porcine DPT burn model. SSD did not delay closure. Hypersensitivity to topical triple antibiotics was common. Applicability of Research to Practice This study provides insight into the topical ointment standard of care for burns and helps establish the standard comparator topical treatment for future preclinical and clinical studies.

Perforation Peritonitis: Clinical Insights from a Three-Year Experience

Background: Peritonitis caused by gastrointestinal perforation is a frequent surgical emergency globally. Early detection and treatment are vital in reducing complications and death. Surgical intervention and good perioperative care improve outcomes. A clinical trial assessed the outcome of perforation peritonitis at a tertiary healthcare institute to identify factors contributing to morbidity and mortality. Materials and Methods: The study conducted at IMS, BHU, was a Prospective Observational Study for 3 years. Patients of all ages presenting with acute abdominal pain and gas under the diaphragm were enrolled. After examination through different methods, after resuscitation, Laparotomy was performed in all patients, followed by thorough peritoneal lavage. The site, size, type, and number of perforations were documented, and biopsy was taken from the edge of the perforation when necessary. Results: The study showed that duodenal ulcer perforation was the leading cause of gastrointestinal perforation, followed by appendicitis, typhoid perforation, and malignancy. Primary closure was the most common surgical procedure, followed by appendectomy, gut resection, and exteriorization. Mortality rate was , and observed morbidity included wound infection, fever, respiratory complications, residual abscess, electrolyte imbalances, burst abdomen, sepsis, cardiac complications, and anastomotic disruption. Conclusion: Gastrointestinal perforation is a common complication of acid peptic disease and typhoid. To control acid peptic disease, NSAIDs and triple therapy for H. pylori eradication can be used. Early and primary treatment for typhoid should be prioritized on a larger scale, and common practitioners should be educated to increase awareness about the disease.

Risks of Immunosuppressive Therapy in Patients Undergoing Open Reduction Internal Fixation for Ankle Fractures

Chronic steroid and immunosuppressant use have been shown to increase the risk for postoperative complications in orthopedic surgery. Further understanding of the risks of immunosuppression is necessary to aid in risk stratification and patient counseling. However, these risks have not yet been explored in ankle fracture patients. Thus, the purpose of this study is to determine whether patients taking immunosuppressives are at an increased risk for morbidity and mortality following open reduction and internal fixation (ORIF) of ankle fractures. Patients undergoing operative treatment for ankle fractures from 2006 to 2018 were identified in the National Surgical Quality Improvement Program database. Patients were categorized based on their use of immunosuppressive medications. Postoperative outcomes assessed included superficial surgical site infections, deep surgical site infections, organ space infections, wound dehiscence, pneumonia, unplanned intubation, pulmonary embolism, urinary tract infection, renal failure, blood transfusion requirement, deep vein thrombosis, sepsis, cardiac arrest, extended length of hospital stay, readmission, reoperation, and mortality. Univariate and multivariate analyses were performed. In total, 10,331 patients underwent operative treatment for ankle fracture. Total 10,153 patients (98.3%) were not taking immunosuppressants and 178 (1.7%) were taking these medications. In multivariate analysis, patients taking immunosuppressants were at increased risk of pulmonary embolism (odds ratio [OR] 4.382; p=.041) and hospital readmission (OR 2.131; p=.021). Use of immunosuppressive medications is an independent risk factor for pulmonary embolism and readmission following ORIF for ankle fractures. Notably, no association with wound complications, infections, or sepsis was identified.

Changes in Injury Pattern and Outcomes of Trauma Patients after COVID-19 Pandemic: A Retrospective Cohort Study.

The COVID-19 pandemic, starting in 2020, changed the daily activities of people in the world and it might also affect patterns of major trauma. This study aimed to compare the epidemiology and outcomes of trauma patients before and after the COVID-19 outbreak. This was a retrospective study, conducted in a single regional trauma center in Korea, and patients were grouped as pre- and post-COVID-19 and compared in terms of demographics, clinical characteristics, and clinical outcomes. A total of 4585 patients were included in the study and the mean age was 57.60 ± 18.55 and 59.06 ± 18.73 years in the pre- and post-COVID-19 groups, respectively. The rate of elderly patients (age ≥ 65) significantly increased in the post-COVID-19 group. In terms of injury patterns, self-harm was significantly increased after COVID-19 (2.6% vs. 3.5%, p = 0.021). Mortality, hospital length of stay, 24 h, and transfusion volume were not significantly different. Among the major complications, acute kidney injury, surgical wound infection, pneumonia, and sepsis were significantly different between the groups. This study revealed changes in the age of patients, injury patterns and severity, and major complication rates after the COVID-19 outbreak.

Incidence of Wound Sepsis and related Factors in Post-Operative Patients in Kampala International University Teaching Hospital Ishaka Bushenyi-Western Uganda

Incidence of Wound Sepsis and related Factors in Post-Operative Patients in Kampala International University Teaching Hospital Ishaka Bushenyi-Western Uganda

Postoperative Pulmonary Complications in the ENIGMA II Trial: A Post Hoc Analysis.

Nitrous oxide promotes absorption atelectasis in poorly ventilated lung segments at high inspired concentrations. The Evaluation of Nitrous oxide In the Gas Mixture for Anesthesia (ENIGMA) trial found a higher incidence of postoperative pulmonary complications and wound sepsis with nitrous oxide anesthesia in major surgery compared to a fraction of inspired oxygen of 0.8 without nitrous oxide. The larger ENIGMA II trial randomized patients to nitrous oxide or air at a fraction of inspired oxygen of 0.3 but found no effect on wound infection or sepsis. However, postoperative pulmonary complications were not measured. In the current study, post hoc data were collected to determine whether atelectasis and pneumonia incidences were higher with nitrous oxide in patients who were recruited to the Australian cohort of ENIGMA II. Digital health records of patients who participated in the trial at 10 Australian hospitals were examined blinded to trial treatment allocation. The primary endpoint was the incidence of atelectasis, defined as lung atelectasis or collapse reported on chest radiology. Pneumonia, as a secondary endpoint, required a diagnostic chest radiology report with fever, leukocytosis, or positive sputum culture. Comparison of the nitrous oxide and nitrous oxide-free groups was done according to intention to treat using chi-square tests. Data from 2,328 randomized patients were included in the final data set. The two treatment groups were similar in surgical type and duration, risk factors, and perioperative management recorded for ENIGMA II. There was a 19.3% lower incidence of atelectasis with nitrous oxide (171 of 1,169 [14.6%] vs. 210 of 1,159 [18.1%]; odds ratio, 0.77; 95% CI, 0.62 to 0.97; P = 0.023). There was no difference in pneumonia incidence (60 of 1,169 [5.1%] vs. 52 of 1159 [4.5%]; odds ratio, 1.15; 95% CI, 0.77 to 1.72; P = 0.467) or combined pulmonary complications (odds ratio, 0.84; 95% CI, 0.69 to 1.03; P = 0.093). In contrast to the earlier ENIGMA trial, nitrous oxide anesthesia in the ENIGMA II trial was associated with a lower incidence of lung atelectasis, but not pneumonia, after major surgery.

An Assessment of the Etiologies Associated With Acute Abdomen Subjected to Exploratory Laparotomy: A Study From a Rural Area of Himachal Pradesh.

Background The aim of this retrospective study is to establish a correlation between clinical features, surgical diagnosis, and the final diagnosis of laparotomies, as well as to establish the relationship between preoperative delay on the outcomes of surgery in the form of mortality and morbidity. Emergency surgery is high-risk in patients with acute abdomen with uncertain diagnosis. The results of surgery are remarkable and provide quick relief to the suffering and agony of patients with the dreadful condition of acute generalized peritonitis. Methodology Patients presenting with complaints of acute abdomen who needed laparotomy based on clinical judgment and investigations were included in this study. The study data were reviewed from April 2007 to January 2011 and March 2014 to February 2016 in a government hospital. Results A total of 174 patients with acute abdomen in whom there was an indication of laparotomy based on clinical judgment and radiological investigations were selected. Most patients had gastrointestinal perforation (n = 115) and acute intestinal obstruction (n = 23). The most important clinical features analyzed were abdominal tenderness (n = 160), guarding (n = 153), distention (n = 75), and tachycardia (n = 63). Conclusions Among the total patients, 150 underwent surgery within 24 hours of the presentation in the emergency and the remaining after 24 hours. The most common cause of laparotomy was a duodenal perforation in 79 patients and gastric perforation in 24 patients. A total of 114 patients developed no complications postoperatively. Among patients who developedpostoperative complications, wound sepsis and acute respiratory distress syndrome were the most common. Mortality was noted in three patients.

Systematic Review and Meta-Analysis: Association between Preoperative Ustekinumab and Surgical Complications in Crohn’s Disease Patients

Introduction: The impact of ustekinumab (UST) therapy on surgical complications in patients with Crohn’s disease (CD) remains controversial. The aim of this meta-analysis is to explore the link between these two. Methods: Databases (PubMed, Web of Science, Cochrane, and Springer Link) were searched until April 2022. Studies of CD patients who received UST and no UST prior to surgery (including no biological therapy, anti-tumor necrosis factor-α [anti-TNF-α] agent, and vedolizumab [VDZ]) were included. Primary outcomes included overall complications, infectious complications, and noninfectious complications. Results: Nine studies totaling 3,225 CD patients were enrolled; 332 patients received UST treatment. There was no evidence of difference in the overall complications (odds ratio [OR] = 0.84, p = 0.37, 95% confidence interval [CI] = [0.57–1.23], I² = 40%) between CD patients who had UST treatment preoperatively and those who had no UST treatment. There was no evidence of a difference in infectious complications (OR = 1.15, p = 0.35, 95% CI = [0.86–1.53], I² = 2%). Additionally, there was no significant evidence of difference between these groups in terms of noninfectious complications and death. Specifically, there was no evidence of difference in overall complications, infection complications (including wound complications, sepsis, abscess, and anastomotic leakage), and noninfection complications (ileus, readmission, and return to operation), compared with no biological therapy and anti-TNF-α agents. At the same time, no significant evidence of difference was discovered in the comparison of preoperative UST and VDZ therapy in terms of overall complications, infectious complications (sepsis and abscess), and noninfectious complications (intestinal obstruction, readmission, and recovery surgery). Conclusion: In general, compared with other biological agents, preoperative use of UST in the treatment of CD patients is usually safe and does not increase surgical complications.