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

Personal and Psychological Perceptions of Return to Activities After Anterior Ligament Reconstruction Among Patients with an Anterior Cruciate Ligament Tear in Jazan Province

Zenat Khired,1 Hussam Darraj,1 Basem Zogel,1 Salman Mohammed Qahl,1 Nawaf Bakri,1 Khalid Ahmed Muafa Jnr,1 Mohammed H Alhazmi,1 Mohammed A Zalah,2 Almutasim Billa Moafa,3 Yahya Mahnashi4 1Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia; 2King Fahad Central Hospital, Jazan, Saudi Arabia; 3Company of United Rehabilitation Experts, Jazan, Saudia Arabia; 4Department of Physiotherapy, Collage of Applied Sciences, Jazan University, Jazan, Saudi ArabiaCorrespondence: Zenat Khired, Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia, Tel +966 50 479 2202, Email [email protected]; [email protected]: The knee joint is primarily stabilized by the Anterior Cruciate Ligament (ACL). ACL tear, a common injury resulting from sudden shock or intense forceful knee movement, is characterized by an ACL sprain or stretch. In Saudi Arabia, the incidence of ACL damage is estimated at 31.4%. Injuries can be contact-based (direct collision) or non-contact (imbalanced or flawed movement).Methodology: This cross-sectional observational study was conducted in the Jazan region of Saudi Arabia between December 2022 and May 2023 to assess personal and psychological perceptions of returning to activities after ACL reconstruction. The study included 113 patients; data was collected via self-administered questionnaire, and data analysis was performed using SPSS 23rd version. This study provides valuable insights into the factors affecting the return to activities after ACL tears.Results: The study found that most patients were male. Football is the most common physical activity associated with knee injury. Postoperative complication rates were low. Sex, site of injury, and reoperation were significantly associated with the perceived importance of the exercise score. Muscle strengthening postoperatively and age were significantly associated with knee injury and osteoarthritis outcome scores. Site of injury and ACL– quality of life score of “social and emotional” segment were significant factors associated with ACL – quality of life score of “entertaining and physical activity” segment. This study provides valuable insights into the factors affecting the return to ACL tear activity in the Jazan region.Conclusion: This study highlights the importance of patient education and support for safe exercise and emotional well-being after ACL. We found correlations between injury location and exercise perception, thus emphasizing the need for a safe environment. Postoperative strengthening and age- and sex-specific strategies are also important, and emotional support is critical for rehabilitation success. Further research on patients’ beliefs, motivations, and provider communication is needed.Keywords: ACL, return to sport, patient-reported outcome, patient perspective, psychology, activity leve

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

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. Funding DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Oral Isotretinoin-Associated Ocular Effects and Risk Factors: A Cross-Sectional Study

Ismail I Abuallut,1 Mohammed Q Dibaji,2 Ahmad Assiri,3 Wedad Mawkili,4 Ahmed Y Najmi,5 Safa Abdu Ageeli,5 Amaal Abdulaziz Hamdi,5 Raum Abdu Ayoub,5 Abdulaziz Yahya Muyidi,5 Hussam T Hakami,5 Abrar Khalid Alhazmi,5 Moayad Hassan Rekini5 1Department of Surgery, Ophthalmology Division, Jazan University, Jazan, Saudi Arabia; 2Prince Mohammed Bin Nasser Hospital - Jazan Health cluster, Jazan, 82943, Saudi Arabia; 3Department of Dermatology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia; 4Department of Pharmacology and Toxicology, College of Pharmacy, Jazan University, Jazan, Saudi Arabia; 5Faculty of Medicine, Jazan University, Jazan, Saudi ArabiaCorrespondence: Ismail I Abuallut, Ophthalmology Division, Jazan University, Jazan, Saudi Arabia, Email [email protected]: Oral isotretinoin is a derivative of vitamin A, used to treat acne vulgaris. One of its effects is altering the corneal surface and ocular glands, resulting in eye dryness and various other symptoms. This study aimed to analyze the impact of systemic isotretinoin treatment on ocular health and investigate the potential risk factors contributing to ocular pathology.Patients and Methods: This cross-sectional study was conducted on 489 participants in the Jazan region using a convenience sampling method. An online questionnaire composed of five sections, including the Arabic version of the validated Ocular Surface Disease Index (OSDI), was used to assess the presence of ocular symptoms associated with isotretinoin usage as well as the potential contributing risk factors.Results: A significant association was established between oral isotretinoin use and specific eye symptoms, including a gritty feeling in the eye (66.4%), sore eyes (68.6%), blurry vision (75.9%), and the need for moisturizing drops (35%). OSDI severity varied according to isotretinoin usage status, with severe OSDI grades reported in 56.9% of current users, 51.2% of those who stopped < 2 months ago, and 38.8% of those who stopped ≥ 2 months ago. Furthermore, significant risk factors associated with worse OSDI grades included contact lens use and isotretinoin dose, with contact lens use being associated with a 17.5-point increase in OSDI scores, while each 10 mg increase in isotretinoin dose was linked to a 0.20-point rise in OSDI score.Conclusion: This study emphasizes the importance of assessing individual risk factors before starting isotretinoin therapy and monitoring ocular health in patients undergoing therapy. Clinicians should be aware of preventive methods and should consider high-risk patients to an ophthalmologist for interventions, such as punctal plugs, that can reduce complications. Further research targeting specific populations with shared risk factors is needed to validate these findings.Keywords: retinoids, ocular pathology, eye dryness, Saudi Arabi