Manuel Durán-Poveda

Incidence of Surgical Site Infection in Colon Surgery: Comparison with Regional, National Spanish, and United States Standards

BACKGROUND The high prevalence of surgical site infection (SSI) in colon surgery, and the clinical and economic impacts of such infections, make its monitoring and prevention a priority. METHODS We conducted a prospective cohort study to estimate the rate of SSI in colon surgery and the degree of compliance with antibiotic prophylaxis and pre-operative preparation protocols. The study population comprised patients who underwent colon surgery at the University Hospital of the Alcorcon Foundation in Alcorcon, Spain, from October 2007 to December 2009. Risk factors, the observance of antibiotic prophylaxis, and compliance with pre-operative preparation protocols were monitored; and their influence on SSIs was followed for 30 days after surgery. The main outcome measure was comparisons of the rates of SSI in patients undergoing colon surgery in Madrid and across the whole of Spain and in the United States, as determined in accordance with the surveillance parameters of the National Nosocomial Infections Surveillance (NNIS) index. RESULTS Among a total of 132 patients, we found a 10.6% rate of SSI. The indirect standardization rate at our hospital was 1.75-fold for the United States and 0.64-fold and 0.61-fold, respectively, the rates for Madrid and all of Spain. The rates of compliance with antibiotic prophylaxis and pre-operative preparation protocols were 93.6% and 56.8%, respectively. No relation could be established between these data and the rate of infection. The risk factors for SSI found in a multivariable analysis were the degree of contamination in surgery and the presence of chronic obstructive pulmonary disease (COPD; p<0.05). CONCLUSIONS The rate of SSI in our study population was below that for Madrid and Spain but higher than that for the United States. Thorough adherence to the monitoring system was essential for obtaining these results.

Surgical site infection incidence and risk factors in knee arthroplasty: A 9-year prospective cohort study at a university teaching hospital in Spain

Background: Surgical site infection (SSI) is one of the complications posed by knee replacement surgery. Hospital‐based infection surveillance systems may provide indicators of improvement and allow the characterization of risk factors critical to reduce infection. The aims of this study were to compare the incidence of SSI in our center with rates in the Madrid Region, Spain, and the United States, and to evaluate any possible SSI‐related risk factor in knee replacement surgery. Methods: All patients who underwent knee replacement surgery at a tertiary hospital in 2008–2016 were included. SSI was defined according to Centers for Disease Control and Prevention criteria. Infection rate was calculated. The association between risk factors and SSI incidence was assessed by reference to odds ratio (OR) with multivariate analysis. Results: The study population (n = 1969) had a global SSI risk of 1.0%. We found a declining trend in the follow‐up period, from an SSI risk of 1.8% in 2009 to 0.4% in 2016. Independent risk factors included hair removal (OR: 3.09, 95% confidence interval [CI]: 1.27–7.50) and National Healthcare Safety Network risk index ≥ 2 (OR: 9.37, 95% CI: 2.90–30.26). Conclusion: This study identified risk factors that showed the necessity to strictly comply with wound decontamination and patient preparation protocols, reduce surgery duration, and identify patients who require comprehensive monitoring.

Adenocarcinoma de la tercera porción duodenal moderadamente diferenciado

BACKGROUND Duodenal carcinoma is very rare. It represents 33-45% of the all tumours of the small bowel. The symptoms are non-specific, and the diagnosis is often accidental. CLINICAL CASE A 35-year old man was admitted to our hospital with post-prandial abdominal pain. Upper gastrointestinal examination revealed a tumour of the third duodenal portion, which was diagnosed, using endoscopic biopsy, as a tubular adenoma with high grade dysplasia. The computed axial tomography scan, the magnetic resonance imaging, and the endoscopic ultrasound showed the neoplasia of the third duodenal portion with no lymph node or peritoneal metastases. Partial resection of the duodenum was performed. The definitive histopathological diagnosis was primary adenocarcinoma of the third duodenal portion. pT2 N0M0, originated in a tubular adenoma. CONCLUSIONS Primitive neoplasia of the duodenum is very rare. Duodeno-cephalo-pancreatectomy is recommended in proximally located tumours, while segmental resection of the duodenum is appropriate for distal locations, with the same survival.

Efecto de la adecuación a protocolo de la profilaxis antibiótica en la incidencia de infección quirúrgica en apendicectomías. Estudio de cohortes prospectivo

BACKGROUND Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection. This study assessed compliance with antibiotic prophylaxis in surgery for acute appendicitis, and the effect of this compliance on surgical site infection. MATERIAL AND METHODS Prospective cohort study to evaluate compliance with antibiotic prophylaxis protocol in appendectomies. An assessment was made of the level of compliance with prophylaxis, as well as the causes of non-compliance. The incidence of surgical site infection was studied after a maximum incubation period of 30 days. The relative risk adjusted with a logistic regression model was used to assess the effect of non-compliance of prophylaxis on surgical site infection. RESULTS The study included a total of 930 patients. Antibiotic prophylaxis was indicated in all patients, and administered in 71.3% of cases, with an overall protocol compliance of 86.1%. The principal cause of non-compliance was time of initiation. Cumulative incidence of surgical site infection was 4.6%. No relationship was found between inadequate prophylaxis compliance and infection (relative risk=0.5; 95% CI: 0.1-1.9) (P>.05). CONCLUSIONS Compliance of antibiotic prophylaxis was high, but could be improved. No relationship was found between prophylaxis compliance and surgical site infection rate.

Epidemiological Surveillance of Surgical Site Infection and its Risk Factors in Cardiac Surgery: A Prospective Cohort Study

INTRODUCTION AND OBJECTIVES Surgical site infection in cardiac surgery is uncommon. The aim of the present study was to examine the incidence of this infection, compare it with national and international data, and evaluate its risk factors. METHODS This prospective cohort study included patients who underwent valve surgery or coronary revascularization during a 6-year period. The incidence of surgical site infection was studied. Associations between risk factors and infection were evaluated using odds ratios (OR). The infection rate was compared with Spanish and American data using the standardized infection ratio. RESULTS A total of 1557 patients were included. The overall cumulative incidence of infection was 4% (95% confidence interval [95%CI], 3.6%-5.6%), 3.6% in valve surgery (95%CI, 2.5%-4.7%) and 4.3% in coronary revascularization (95%CI, 2.3%-6.3%). Risk factors for surgical site infection in valve surgery were diabetes mellitus (OR=2.8; P<.05) and obesity (OR=6.6; P<.05). Risk factors for surgical site infection in coronary revascularization were diabetes mellitus (OR=2.9; P<.05) and reoperation for bleeding (OR=8.8; P<.05). CONCLUSIONS Diabetes mellitus and obesity favor surgical site infection in valve surgery, whereas diabetes mellitus and reoperation for bleeding favor surgical site infection in coronary revascularization. Infection surveillance and control programs permit evaluation and comparison of infection rates in cardiac surgery.