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

Timing of surgery following SARS-CoV-2 infection:an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. From 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odd ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odd ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.</p

Facteurs associés à une première grossesse chez les femmes Malgaches ayant accouché dans un hôpital de maternité d'Antananarivo: une étude de cohorte rétrospective

Introduction: Il y a très peu de littératures africaines et Malgaches concernant les détails sur les facteurs de risques qu'encourent les primigestes en général. Le but de notre étude est de déterminer les facteurs de risques potentiels associés à une première grossesse. Méthodes: Une étude cohorte rétrospective a été menée auprès des femmes primigestes et multigestes de l'hôpital Pavillon sainte Fleur entre Octobre 2014 et Décembre 2016. Les risques relatifs étaient ajustés après contrôle avec les caractéristiques sociodémographiques. Résultats: Les primigestes étaient beaucoup plus exposées à un travail prolongé de plus de 12h (RRa = 2,28; IC 95% 1,74-3,00), à une césarienne en urgence (RRa = 1,47; IC 95% 1,35-1,60) et à une épisiotomie (RRa = 2,98; IC 95% 2,61-3,40). Leurs enfants étaient plus susceptibles de présenter des signes de souffrance foetale avec anomalie du rythme cardiaque foetale au cours de la phase de travail (RRa = 1,96; IC 95% 1,45-2,65) et un risque accru d'être admis dans une unité de soins intensifs après l'accouchement (RRa = 2,08; IC 95% 1,25-3,45). Conclusion: Les complications survenues pendant le travail auraient exposé les primigestes à d'autres risques en cascades sur l'issue de leurs accouchements et sur la santé de leurs enfants. La prise en charge des primigestes nécessiterait, de la part des personnels médicaux, une attention particulière sur la durée de la phase de travail

Assessment of enteral nutrition through feeding stomas or gastric tubes in digestive surgery

Ostomy feeding remains a reference approach for enteral nutritional assistance. In Madagascar, the techniques are still conventional surgical procedures due to the lack of adequate endoscopic equipment. This study aims to evaluate the benefits and risks of enteral nutrition with a two-week follow-up. Included patients who had benefited from enteral nutrition by tube feeding using nasogastric, gastrostomy, and jejunostomy tubes over six months in Joseph Ravoahangy Andrianavalona Hospital. Prevalence, age and gender, current body mass index (BMI), weight, nutritional grade, initial pathology, psychological status, comorbidities, type of feeding stoma, and the surgical technique (gastrostomy or jejunostomy) were studied. After 15 days, the effectiveness of enteral nutrition was assessed using BMI, serum albumin, C-Reactive Protein (CRP) level, as well as postoperative complications and quality of life. The patient's outcome on the 15th day has been determined. The Chi-square test analyzed the associations and Mann Whitney test compared the effects of enteral nutrition by ostomy and gastric tube use. Forty-two patients were included, aged 47(17-78). The sex ratio was 0.5. Initially, the body mass index was 17(12-23) kg/m², the serum albumin value 3.4 (2.5-4.7) gr/dl with a median CRP level of 16 (2-74.2) mg/l. Nutritional assistance resulted in a weight variation between baseline and 15th day. Comparing enteral nutrition by ostomy and gastric tube, only variation of C Reactive Protein on the 15th day has a significative difference. Mortality was 33% (gastrostomy), 31% (jejunostomy), 24% (nasogastric tube). Nutritional support and the choice of ostomy or gastric tube for enteral nutrition were not associated with mortality. The effectiveness of nutritional assistance is still questionable in this study if the results are more promising in the literature. The death rate linked to the initial pathology and the general state of the patients is still considerable, hence the interest in decision-making in multidisciplinary consultation meetings.</jats:p

Assessment of enteral nutrition through feeding stomas or gastric tubes in digestive surgery

Ostomy feeding remains a reference approach for enteral nutritional assistance. In Madagascar, the techniques are still conventional surgical procedures due to the lack of adequate endoscopic equipment. This study aims to evaluate the benefits and risks of enteral nutrition with a two-week follow-up. Included patients who had benefited from enteral nutrition by tube feeding using nasogastric, gastrostomy, and jejunostomy tubes over six months in Joseph Ravoahangy Andrianavalona Hospital. Prevalence, age and gender, current body mass index (BMI), weight, nutritional grade, initial pathology, psychological status, comorbidities, type of feeding stoma, and the surgical technique (gastrostomy or jejunostomy) were studied. After 15 days, the effectiveness of enteral nutrition was assessed using BMI, serum albumin, C-Reactive Protein (CRP) level, as well as postoperative complications and quality of life. The patient&apos;s outcome on the 15th day has been determined. The Chi-square test analyzed the associations and Mann Whitney test compared the effects of enteral nutrition by ostomy and gastric tube use. Forty-two patients were included, aged 47(17-78). The sex ratio was 0.5. Initially, the body mass index was 17(12-23) kg/m², the serum albumin value 3.4 (2.5-4.7) gr/dl with a median CRP level of 16 (2-74.2) mg/l. Nutritional assistance resulted in a weight variation between baseline and 15th day. Comparing enteral nutrition by ostomy and gastric tube, only variation of C Reactive Protein on the 15th day has a significative difference. Mortality was 33% (gastrostomy), 31% (jejunostomy), 24% (nasogastric tube). Nutritional support and the choice of ostomy or gastric tube for enteral nutrition were not associated with mortality. The effectiveness of nutritional assistance is still questionable in this study if the results are more promising in the literature. The death rate linked to the initial pathology and the general state of the patients is still considerable, hence the interest in decision-making in multidisciplinary consultation meetings. [Med-Science 2023; 12(1.000): 161-6

EPIDEMIOLOGIE DU CANCER GASTRIQUE : EXPERIENCE D’UN CENTRE HOSPITALIER UNIVERSITAIRE D’ANTANANARIVO EPIDEMIOLOGY OF GASTRIC CANCER: EXPERIENCE OF AN UNIVERSITY HOSPITAL CENTER IN ANTANANARIVO

Background: The management of gastric cancer is a major challenge in low-income countries. The aim of this study was to describe the epidemiological, clinical and therapeutic aspects of gastric cancer in the Visceral Surgery ward of the Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona  in Antananarivo. Materials and Method: This was a descriptive retrospective study conducted from January 2010 to December 2016. All patients over 18 years of age hospitalized for gastric cancer with histological confirmation were included in the study. The epidemiological, clinical and therapeutic methods were analyzed. Outcome assessment will not be the subject of this study. Results: Gastric cancer was confirmed in 68 patients. The average age was 56.5. Helicobacter pylori infection was the main risk factor. Gastrointestinal  bleeding and chronic epigastric pain were the most revealing clinical manifestations. Ulcerous and exuberant gastric injuries were the most frequent, preferentially located in the pyloric antrum (n = 38). Surgery was curative in 24 patients, palliative in 13 patients. Four patients received primary chemotherapy and 27 refused to continue treatment when the diagnosis was announced. Papillary adenocarcinoma was the most common histological type (n = 32). Conclusion: gastric cancer is discovered at an advanced stage in our center. Currently, all age groups are exposed to risk factors. Endoscopic screening and eradication of Helicobacter Pylori infection should be mandatory. Multidisciplinarity is essential in the management.</jats:p