Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Buccal One-Stage Mucosal Graft Urethroplasty for Urethral Stricture. Results of 10 Years of Experience.

Aim: Representing our data regarding use of buccal mucosa for treatment of recurrent urethral stricture. Evaluating effectiveness of buccal graft for reconstruction of urethral segment both penile and bulbar urethra. Materials and methods: We repaired 95 urethral strictures with buccal mucosa grafts from 2004 to 2015. Mean patient age was 39 years. The etiology of stricture was unknown in 54% of cases in other cases ischemia, trauma, instrumentation was the reason. 96% had undergone previous urethrotomy or dilation. The buccal mucosa graft was harvested from lower lip mostly. Mean graft length was 3.8 cm. The graft was placed on the ventral and dorsal bulbar urethral surface in 61 and 34 cases, respectively. In pendulous urethra we routinely use the dorsal graft the Asopa inlay graft or Barbagli onlay graft. Clinical outcome was considered a success or failure at the time that any postoperative procedure was needed, including dilation. Mean follow-up was 36 months (range 16 to 62). Results: We had a success rate of 77% with dorsal inlay or onlay flap for pendulous urethra inferior than ventral graft used for bulbar urethra which was 81% success rate. Conclusions: In our experience the placement of buccal mucosa grafts into the ventral or dorsal surface of the bulbar urethra showed an acceptable success rates 81% and 77% respectively. Longer times of follow up is need to see if the results deteriorated more

ACTES 2020 - Abstracts Book; The 4th Albanian Congress of Trauma and Emergency Surgery.

The spread of the Corona virus, first identified in China in December 2019, spread to Europe and was recognized as a pandemic by the World Health Organization (WHO) on March 11th.Measures to achieve social distancing have been implemented in different periods and rates of time around the World.The traumatic and non-traumatic emergency patient needs timely and competent care throughout the treatment chain, relying on broad-based competence, multidisciplinary teamwork and communication. In a medical field that is moving towards increasing subspecialization, it is easy to see how the quality of care of these groups of patients can be improvedACTES throughout its topic focuses on these important groups of patients, patients with critical illness and surgical impairment, during the development of ACTES as an online event will try to bring together groups of health professionals to improve, optimize, inspire, and to provide the opportunity for networking and learning from each other.While of course there is a major focus on managing Covid-19 patients at the moment and for a longer period thereafter, the greatest impact on mortality and morbidity is likely to be in those patients who may not have access to care specialized due to lack of resources or due to less attention. We want to take this opportunity to remind everyone that we as traumatic and non-traumatic emergency surgeons have a duty to insure the sick and seriously injured during this period as well.</jats:p

ACTES 2017 - Abstracts Book; The 1st Albanian Congress of Trauma and Emergency Surgery

ASTES has organized an attractive scientific program, in partnership with the Surgical and Medical Societies of our country. In addition, we have prepared several special lectures by national and international speakers.The “Frederic Shiroka” lecture will be given by Professor Flamur Tartari, a distinguished surgeon who hasbeen the chief of general surgery service over the years as the father of Albanian modern surgery. He willdeliver his lecture titled “A lifetime with surgical patients”.The pre-conference course for medical personnel (BLS &amp; D) will be available a day before the conference.Finally, we would like to thank all members of the organizing and scientific committees for their hard work in the past few months to ensure that every aspect of the conference is smooth and with the highest standards.Without their hard work and dedication, this conference would not have been possible. Let us express specialthanks to all speakers, particularly to our distinguished international faculty who honored us with theirpresence. </jats:p

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

ACTES 2019 - Abstracts Book; The 3rd Albanian Congress of Trauma and Emergency Surgery

This event reflects the author's involvement in internationally recognized education and training models, as ATLS, ETC, and DSTC, and  UEMS Boards of Emergency SurgeryDo different countries need very different things? I don’t think so, for the simple reason that in Europe and about the challenges we face, with regard to trauma and other medical and surgical emergencies, similarities are much greater than differences.• We all agree on the need for a trauma system “to assure that patients (…) seamlessly receive the proper care, in the proper locations, with proper interventions and, if necessary, transfer to a hospital able to provide the best and most appropriate care” (www.aast.org).• We all agree that teamwork is necessary for prehospital care, transportation, emergency room care, intensive care, surgery, and in/post-hospital rehabilitation.• We all agree on the need for trauma registries with, as much as possible, global follow-up of patient's course.• And finally, we all agree that it is necessary to educate, how to prevent and how to treat.This is also apparent from the recommendations of the European Trauma Course Organization (ETCO) about equipment and facilities: complete trauma team, trauma admission bay close to the ambulance entrance, enough space and adequate lighting, the adjacent operating room to allow emergency procedures, standardequipment for the initial management of major trauma, immediate availability of additional equipment as difficult airway equipment, X-ray, ultrasound machine, surgical instruments, readily available bloodproducts and massive transfusion equipment, co-located CT scanner to allow immediately imaging and access to angiography and interventional radiology, 24 hours a day within 30-60 minutes of request.</jats:p

ACTES 2018 - Abstracts Book

Introduction: although the term “polytrauma” has been in use for decades, no generally accepted definition exists. Our definition has been until 2010: a combination of injuries where one, or the combination where one, or the combination of injuries himself is directly life threatening, in detail is meant: injury to two body cavities, or injury to one cavity committed by two long bone fractures, where spine and unstable pelvis has counted similarly as an injury to a cavity organ.&#x0D; Since 2013 a new definition has been established, the so-called Berlin definition.&#x0D; "A polytrauma means significant injuries of three or more points (AIS) in two or more different anatomic AIS regions in conjunction with one or more additional variables from 5 physiologic parameters: Hypotension (SBP - Systolic Blood Pressure &lt;= 90 mm Hg); Level of consciousness (GCS - Glasgow Coma Scale) ≤ 8; Acidosis (BE - Base Excess ≤ - 5.0); Coagulopathy (INR - International Normalized Ratio ≥ 1.4; PTT - Partial Thromboplastin Time ≥ 40 seconds, and Age ≥ 70 years).&#x0D; This definition fits the reality perfectly.&#x0D; The role of the surgeon in the trauma team is essential. It should provide multidisciplinary care to reduce diagnostic time and optimize therapeutic procedures.&#x0D; As Medicine adapts to the 21st century, new specialties arise. In the management of trauma, two models have been opposed in the past: on one side, a Trauma Surgeon based system, with specialists fully devoted to trauma care, often able to fix skeletal trauma too; on the other hand, blended systems with General Surgeons dealing with both elective and emergency surgery and trauma patients.&#x0D; The evolution of technology, of the epidemiology of trauma, and of the trauma systems and networks entailed the emerging of the concept of Acute Care Surgery. In the vast majority of Countries, this new specialist seems to better fit with the needs of both patients and health organization.&#x0D; Who is the Acute Care Surgeon? What is his minimal educational and technical background? How can interact with the other medical specialists playing around a trauma patient?</jats:p