Applying Best Practices for The Prevention of Surgical Site Infection (SSI) and Reducing Risk Factors for Patients: Meta-Analysis Theoretical Review

This study aimed at providing a comprehensive range of evidence-based recommendations for interventions to be applied during the pre-, intra- and postoperative periods for the prevention of the surgical site infection SSI, while also considering aspects related to resource availability and values and preferences. An initial search identified more than 200 titles published in 2006-2017 as relevant for data extraction, the researchers dealt with the extracted information included study design and methodology, reported cumulative incidence and post-surgical time until onset of SSI, and odds ratios and associated variability for all factors considered in univariate and/or multivariable analyses. And then the study recommended the best producers for reducing the risk factors for patients by conducting the findings of the meta-analysis theoretical review. Keywords: Surgical Site Infection, Risk Factors, Best Practices, Patient

Randomized, controlled blind study comparing sacroiliac intra-articular steroid injection to radiofrequency denervation for sacroiliac joint pain

Background and objective: Sacroiliac joint pain is a common cause for chronic axial low back pain, with up to 20% prevalence rate. To date, no effective long-term treatment intervention has been embarked on yet. The aim of our study was to compare steroid block to radiofrequency ablation for SIJ pain conditions. Methods: A randomized, blind, study was conducted in 30 patients with sacroiliac joint pain. Fifteen patients received radiofrequency denervation of L4–5 primary dorsal rami and S1–3 lateral sacral branch, and 15 patients received steroid under fluoroscopy. Those in the steroid group who did not respond to steroid injections were offered to cross over to get radiofrequency ablation. Results: At 1-, 3- and 6-months post-intervention, 73%, 60% and 53% of patients, respectively, gained ⩾50% pain relief in the radiofrequency (RF) ablation group. In the steroid group, at one month postintervention follow-up, only 20% gained ⩾50% pain relief, but failed to show any improvement at 3 month and 6 month follow-up. Conclusions: Radiofrequency ablation at L4 and L5 primary dorsal rami and S1–3 lateral sacral branch may provide effective and longer pain relief compared to the classic intra-articular steroid injection, in properly selected patients with suspected sacroiliac joint pain. Larger studies are called for to confirm our results, and lay out the optimal patient selection and treatment parameters for this poorly comprehended disorder

Immediate post-discectomy percutaneous facet nerve continuous and nerve root pulsed radiofrequency and intraluminal injection of steroid with hyaluronidase improved outcome of surgery for lumbar disk herniation

Objectives: Evaluation of effects of postoperative (PO) facet nerve continuous thermal radiofrequency neurotomy (CTRFN), nerve root pulsed RF (PRF) and triamcinolone with hyaluronidase injection on outcome of patients undergoing open lumber discectomy. Patients & methods: Seventy patients were allocated into the following groups: Group S underwent open discectomy alone and Group M underwent open discectomy followed by the three adjuvant procedures. Low back pain (LBP) severity was assessed using numeric rating scale (NRS) and disability was assessed using the Oswestry Disability Index (ODI). Primary outcome measure was at least 50% improvement of NRS and ODI. Secondary outcome involved scoring of pain medication requirements, Odom's criteria for improvement of preoperative abnormal findings and patients' satisfaction. Results: Throughout 12-m follow-up, mean NRS and ODI scores of all patients were significantly lower than preoperative scores with significantly lower scores in group M than in group S. Frequency of patients had ⩾50% improvement which was significantly higher in group M than in group S. Patients of both groups showed significant reduction of scoring of consumed analgesics with significantly less consumption of PO analgesics in group M than in group S. Odom's scoring, resumption of activity and overall satisfaction scoring were significantly higher in group M than in group S. Conclusion: Open discectomy provided significant improvement of LBP and disability secondary to LDH. Discectomy with adjuvant therapy including PRF, CTRFN and triamcinolone and hyaluronidase intraluminar injection significantly improved outcome compared to discectomy alone

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially