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

Assessment of quality of life after laparoscopic GERD surgery in children: a prospective study

International audienc

A correlation between Magnetic Resonance Spectroscopy (1-H MRS) and the neurodevelopment of two-year-olds born preterm in an EPIRMEX cohort study.

International audienceBACKGROUND: Preterm infants are at risk of neurodevelopmental impairments. At present, proton magnetic resonance spectroscopy (1H-MRS) is currently used to evaluate brain metabolites in asphyxiated term infants. The purpose of this study was to identify in the preterm EPIRMEX cohort any correlations between (1H-MRS) metabolites ratio at term equivalent age (TEA) and neurodevelopmental outcomes at 2 years. METHODS: Our study included EPIRMEX eligible patients who were very preterm infants (gestational age at birth ≤32 weeks) and who underwent a brain MRI at TEA and (1)H-MRS using a monovoxel technique. The volumes of interest (VOI) were periventricular white matter posterior area and basal ganglia. The ratio of N Acetyl Aspartate (NAA) to Cho (Choline), NAA to Cr (creatine), Cho to Cr, and Lac (Lactate) to Cr were measured. Neurodevelopment was assessed at 24 months TEA with ASQ (Ages and Stages Questionnaire). RESULTS: A total of 69 very preterm infants had a 1H-MRS at TEA. In white matter there was a significant correlation between a reduction in the NAA/Cho ratio and a total ASQ and/or abnormal communication score, and an increase in the Lac/Cr ratio and an abnormality of fine motor skills. In the gray nuclei there was a trend correlation between the reduction in the NAA/Cho ratio and sociability disorders; and the increase in the Lac/Cr ratio and an anomaly in problem-solving. CONCLUSIONS: Using NAA as a biomarker, the vulnerability of immature oligodendrocytes in preterm children at TEA was correlated to neurodevelopment at 2 years. Similarly, the presence of lactate at TEA was associated with abnormal neurodevelopment at 2 years in the preterm brain

Multi-center evaluation of the first, low-cost, open source and totally 3D-printed pediatric laparoscopic trainer

Objective: This study created and evaluated the face validity of a novel, low-cost, three-dimensional printed pediatric laparoscopic trainer and compared it to a standard laparoscopic trainer (LT). Design: We developed the Space Child Laparoscopic Trainer (SCLT) using fused deposition modeling technology with a Bambulab P1S 3D printer.The cost per unit was five euros and the assembly time was 10 min. The printing time was 543 min for 434 g of polylactic acid filament (PLA). A smartphone was used as the camera.The performance of experienced surgeons and surgical residents was evaluated on SCLT and LT using the Objective Structured Assessment of Technical Skill score (OSATS) and time spent. Two fundamental laparoscopic tasks, peg transfer and precision cutting, were randomly performed by each trainer. Participant satisfaction was assessed using a questionnaire. This study assessed the learning speed of surgical residents using the SCLT compared to a standard LT through a non-inferiority test. The test results were compared with those of a control group of experienced senior surgeons. Setting: A medical training program was set up for first-year surgery residents from different French cities (Rouen, Caen, Amiens, and Lille) at the Medical Training Center of Rouen, in collaboration with the University Hospital of Rouen. Participants: Ten pediatric surgeons with at least ten years of experience in laparoscopic surgery, 51 first-year surgical residents, and six external evaluators with at least five years of laparoscopic experience. Results: In total, 200 exercises were performed by 50 residents. The estimated learning speed was +0.139 (95 % confidence interval [CI]: +0.053–+0.252, p = 0.01) for LT and +0.153 (95%CI: +0.035–+0.243, p = 0.004) for SCLT. The estimated learning speed ratio for the SCLT compared to that for the LT was 1.10 (95%CI: 0.35–3.46, p = 0.09 for non-inferiority to 0.50). Conclusions: The results demonstrated a similar performance between the SCLT and standard LT for resident training in pediatric surgery. The widespread dissemination of this tool to residents and surgeons, especially in developing countries, may allow easier access to laparoscopic training

Tocolysis and Neurodevelopment of Children Born Very Preterm

International audienceImportance : Neurodevelopmental outcomes of very preterm children exposed to tocolytics are not well described. Objective : To investigate whether tocolysis administered after spontaneous preterm labor is associated with neurodevelopmental outcomes at 5.5 years and to assess whether the type of tocolytic drug is associated with neurodevelopmental outcomes among infants exposed. Design, Setting, and Participants: This prospective, national, population-based cohort study used data from the French Etude Épidémiologique sur les Petits Âges Gestationnels-2 cohort. Children who were alive and participated in an assessment at 5.5 years and whose mothers experienced spontaneous preterm labor without an infectious context and delivered at 24 to 31 weeks were eligible for this study. Recruitment occurred from March to December 2011. Follow-up at age 5.5 years was conducted from September 2016 to December 2017. Data analysis was performed from July 2023 through April 2024. Exposures: The primary analysis examined tocolytics (yes vs no), and the secondary analysis examined the type of tocolytic (atosiban vs calcium channel blockers [CCBs]). Main Outcome and Measure: The composite outcome neurodevelopmental disabilities included cerebral palsy; visual, hearing, and cognitive deficiencies; developmental coordination disorders; or behavioral problems. Results : A total of 1055 mothers (mean [SD] age, 29.2 [5.7] years) had preterm labor without fever and gave birth to 1320 children (704 male [weighted percentage, 53.3%; 95% CI, 50.6%-56.1%]; mean [SD] gestational age, 28.8 [2.0] weeks). Overall, 776 mothers (weighted percentage, 73.5%; 95% CI, 70.8%-76.2%) received tocolytics; 136 mothers (weighted percentage, 17.9%; 95% CI, 15.3%-20.8%) received only a CCB, and 295 mothers (weighted percentage, 37.6%; 95% CI, 34.2%-41.0%) received only atosiban. From modified Poisson regression with propensity score matching, the risk of overall neurodevelopmental disabilities (mild, moderate, or severe) at 5.5 years did not differ between preterm children exposed and not exposed to tocolytics (relative risk [RR], 1.11; 95% CI, 0.85-1.45; P =.44) or in preterm infants exposed to atosiban compared with those exposed to CCBs (RR, 0.94; 95% CI, 0.67-1.32; P =.71). Conclusions and Relevance: In this study, tocolytics were not associated with neurodevelopmental disabilities among very preterm children surviving at 5.5 years

A new method based on template registration and deformable models for pelvic bones semi-automatic segmentation in pediatric MRI

International audience<p>In this paper we address the problem of bone segmentation in MRIimages of children, in the region of the pelvis. To cope with the complex structure of the bones in this region and their changing topologyduring growth, we propose a method relying on 3D bone templates.These models are built from 3D CT images. For a given MRI volume, the closest template is chosen and registered on the MRI data.This leads to an initial segmentation which is then refined using a deformable model approach, where the regularization parameters depend on the local curvature, and the landmarks used during the registration are fixed anchors during the deformation. This approach wassuccessfully applied to 15 MRI volumes of children between 1 and18 years old, with an average accuracy in terms of medium distanceof M D = 1.17 ± 0.29 mm and Dice Index of DC = 0.81 ± 0.04.</p