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 <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <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.Peer reviewe

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

Evaluation of Healing Intervals of Incisional Skin Wounds of Goats Closed with Three Suture Patterns

The aim of this study was to compare the healing intervals among simple interrupted (SI), ford interlocking (FI) and subcuticular (SC) suture patterns in goats. We hypothesized that these common suture patterns used for closure of incisional skin wounds may have effect on the healing interval. To test this hypothesis, two parameters (subjective healing interval and histologic objective healing interval) were used to investigate the healing interval of the three suture patterns. Our findings showed that, there was significant differences (P&lt;0.05) in subjective healing interval between subcuticular (SC) withford interlocking (FI), but there was nosignificant difference between subcuticular with simple interrupted patterns. There were also no significant differences between ford-interlocking and simple interrupted. Histologic findings at seventh day post surgery revealed low polymorphonuclear leukocytes (PMNL) infiltrations and early fibroblast, collagen fibers and epidermal keratinization in the subcuticular group in comparison with the two other groups. At fourteen day post-surgery, there was marked reduction of inflammatory infiltrates in the subcuticular group when compare with the two other groups, while the collagen fiber density and epidermal keratinization increased in the subcuticular group. At twenty first-day post - surgery , there were no inflammatory cells in subcuticular group, while collagen density was higher, and the orientation of the collagen fibers were horizontal, suggestive of faster healing in comparison with the simple interrupted and ford interlocking groups. It was concluded as measured by subjective healing interval and histologic objective healing interval that surgical skin-wound closed by subcuticular suture pattern alone healed faster than simple interrupted and ford interlocking suture patterns reinforced after subcuticular closure, on the other hand simple interrupted pattern healed faster than ford interlocking.Keywords: Incisional wound healing, histology, goat, suture patterns, healing interva

Prevalence and antibiotic susceptibility of Listeria monocytogenes in raw milk from cattle herds within Sokoto Metropolis, Nigeria

One hundred and ninety two raw milk samples were collected from lactating cows identified in Fulani herds and small scale dairy farms within Sokoto metropolis in order to investigate the presence and determine the antibiotic susceptibility of Listeria monocytogenes in the milk. Selective culture and identification method was employed for the bacterial isolation and Kirby-Bauer technique was used for the antibiotic susceptibility test. Seventy six samples (39.58%) were positive for Listeria species, which upon biochemical characterization 39(51.3%) were Listeria innocua, 14(18.4%) Listeria ivanovii, 17(22.4%) Listeria monocytogenes, 4(5.3%) Listeria welshimeri and 2(2.6%) Listeria seeligeri. Antibiotic susceptibility test of the isolates revealed high resistance to am picillin (100%), and streptomycin (80%), followed by ampiclox (70%), tetracycline (30%), then gentamycin (20%) while, there was no resistance to ciprofloxacin and chloranphenicol. The findings of this study necessitate the need for extension personnel to educate the Fulani herdsmen, milk handlers and other livestock producers on the significance of hygiene especially during milking and the effect of indiscriminate use of drugs particularly antibiotics. There is also need for the agencies concerned such as the National Agency for Food and Drugs Administration and Control (NAFDAC) to regulate the sales and use of both human and veterinary drugs by drug hawkers and other non-professional veterinary practitioners

Management of supernumerary limb in an Ouda lamb: A case report

An Ouda lamb with supernumerary limb was presented to Veterinary Teaching Hospital, Usmanu Danfodiyo University, Sokoto, five days post lambing. The accessory limb was underdeveloped and attached to a flocculating fluid filled skin flap located around the first 3 cervical vertebrae. The congenital anomaly was diagnosed as the presence of supernumerary limb (SL), and was managed surgically. Surgical correction under sedation and local infiltration resulted in normal locomotion and better aesthetics of the lamb