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

Comparison of adjustable continence therapy periurethral balloons and artificial urinary sphincter in female patients with stress urinary incontinence due to intrinsic sphincter deficiency

International audienceIntroduction and hypothesis - The objective was to compare the outcomes of the ACT® device with those of the artificial urinary sphincter (AUS) AMS 800 in the treatment of stress urinary incontinence (SUI) due to sphincter deficiency in women.Methods - All the women who underwent surgical treatment for SUI due to intrinsic sphincter deficiency from 2007 to 2017 were included in a single-center retrospective study. The primary endpoint was the functional outcome. Perioperative functional parameters of the two groups were compared.Results - Twenty-five patients underwent an ACT® implantation and 36 an AUS implantation. Patients in the AUS group were younger (62.9 vs 70.4 years; p = 0.03) with less comorbidity (ASA Score = 3 in 12.1% vs 33.3%; p = 0.005). Operative time and hospital stay were shorter in the ACT® group (45.7 vs 206.1 min; p Conclusions - In the present series, keeping in mind the significantly different baseline characteristics, AUS implantation was associated with better functional outcomes than the ACT® in female patients with SUI due to intrinsic sphincter deficiency, but with a higher intraoperative complications rate, longer operative time, and a longer stay.<br

Impact d’une aganglionnose colique induite sur la barrière épithéliale chez un modèle gros animal

Impact d’une aganglionnose colique induite sur la barrière épithéliale chez un modèle gros animal. 73. Congrès de la Société Française de Chirurgie Pédiatrique (SFCP

Impact on the epithelial barrier of an induced rectal aganglionnosis in a large animal model

Impact on the epithelial barrier of an induced rectal aganglionnosis in a large animal model. 17. Annual Congress of the European Paediatric Surgeons’ Association (EUPSA

The Changing Face of Artificial Urinary Sphincter Use in France The Future is Female

International audienceAnalyzing concurrently data from the manufacturer and from a national comprehensive administrative claim database (PMSI)we found that, overall, the total number of AUS implanted (male+female) increased from 2012 to 2017 (+8.8%). This growth was driven by a strong increase in the number of female implants from 2015 to 2017 (+28.9%). Meanwhile, the number of AUS implanted in male patients remained roughly stable and the total number of anti-incontinence surgery in men (slings+AUS) decreased steadily over the period studied

BAC treatment of the rectosigmoid in piglet: a reproducible model of partial aganglionnosis ina large animal

International audienceabsen