8 research outputs found

    Descripción y correlación del estado nutricional en escolares de 8 a 10 años pertenecientes al establecimientos Educacional Munipalizado "Escuela Carlos Hernández Peña" de la comuna de Peñalolén , Región Metropolitana, Chile 2014

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    Tesis (Licenciatura en Kinesiología)Objetivo: Describir el estado nutricional y correlacionar el IMC y CC de niños de 3° y 4° básico, pertenecientes al colegio municipal “Escuela Carlos Hernández Peña” de la comuna de Peñalolén de la ciudad de Santiago, Chile. Método: Esta investigación corresponde a un estudio de diseño descriptivo de correlación y corte transversal. La población total evaluada en este estudio fue de 68 alumnos de ambos sexos, entre 8 y 10 años, 11 meses y 30 días de edad. La medición del IMC se hizo mediante una Balanza mecánica SECA®, (estatura y el peso del niño/a) y el CC con una cinta métrica inextensible marca Dynatronics. Además, se evaluó el consumo de frutas y verduras de los niños/as a través de 2 preguntas extraídas del módulo Dieta de la ENS 2009-2010. Se utilizó el programa Microsoft Excel® 2010 para el análisis de los resultados. Resultados: La mayoría de los alumnos evaluados presentó un IMC normal, siendo las niñas las que obtuvieron mayor IMC en comparación a los hombres. La CC de las niñas que se encontraban en el p90 superó el punto de corte de las mujeres adultas. En cuanto a la correlación entre estos términos hay asociación directa con un valor de 0,86 y un nivel de significancia p<0,05. En general los alumnos presentan un mayor consumo de verduras que de frutas.Objective: Describe the nutritional status and correlate the Body Mass Index (BMI) and Waist Circumference (WC) of children from 3rd and 4th grade enrolled in the municipal school “Carlos Hernandez Peña” from the commune of Peñalolen in the city of Santiago of Chile. Method: This survey consists in a correlated descriptive cross-sectional study. The total population evaluated in this study was 68 students from both genres, between 8 and 10 years old, eleven months and 30 days. The measurement of the BMI was made with a weighing scale SECA (height and weight of boy/girl) and the WC with a Dynatroics measuring tape. Additionally, intake of vegetable and fruit was also evaluated through two questions taken from the National Health Survey (NHS) 2009-2010 diet module. Microsoft Excell 2010 program was used to analyze the results of the survey. Results: The majority of the students evaluated showed a normal BMI, but the girls were the ones who rated higher BMI than boys. The WC of the girls who were in the percentile 90 exceeded the cut-off point of women. As regards the correlation between these terms there is a direct association with a value of 0,86 and a significance level of p<0,05. In general the students show a higher consumption of vegetables than fruit

    Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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    Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

    Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

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    Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

    La pandemia en/desde Jujuy: reflexiones situadas

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    Acaso no podrí amos afirmar que la pandemia llego a nuestra sociedad mundial causando un pandemo - nium?. En cierto modo, ma s alla del juego de palabras, gran parte de nosotros lo sentimos así . Es claro, una pandemia, es una enfermedad que afecta a la sociedad. Perturba intensamente la cotidianeidad, las ocupaciones, y, en general, lo que en estos dí as an oramos como la “vida normal” de todos. Si contraemos una enfermedad ma s o menos aguda, todas nuestras actividades se ven afectadas, se desordenan. Cuando ello ocurre, pra cticamente debemos concentrarnos, casi con exclusividad, en superar la afeccio n con la ayuda de profesionales de la salud, cualquiera sea el abordaje disciplinario que nos resulte ma s adecuado y confiable. Así , del mismo modo, la pandemia afecta a toda la comunidad, a todas sus actividades. Y, en este caso tambie n la principal preocupacio n es superar la afeccio n. Entonces hay que buscar alternativas para el resto de las tareas, que deben transcurrir entre los estrechos ma rgenes que nos permiten tanto el cuidado personal como el social, ambos imprescindibles.Fil: Aramayo, Anahí. Universidad Nacional de Jujuy; ArgentinaFil: Lopez, Andrea Noelia. Universidad Nacional de Jujuy; ArgentinaFil: Díaz, Rodrigo Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Astorga, Farid Diego. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Assad, Lucas Gabriel. Universidad Nacional de Jujuy; ArgentinaFil: Hoyos, Gustavo Daniel. Universidad Nacional de Jujuy; ArgentinaFil: Balut, Jorgelina. No especifíca;Fil: Angulo Villán, Florencia Raquel. No especifíca;Fil: Brailovsky, Sofia Miriam. No especifíca;Fil: Carrizo, María José. No especifíca;Fil: Bustamante, Patricia. No especifíca;Fil: Jaled, Daniela Alejandra. No especifíca;Fil: Castillo, Silvina Ana Lia. No especifíca;Fil: Díaz, Enrique Antonio. No especifíca;Fil: Cieza, Fernanda. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Cuva, Cecilia Alejandra. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Rivas, Rosana Verónica. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Altea, Laura. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Garzon, Analia Soledad. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mamani, Claudia. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Villarroel, Viviana Mabel. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; ArgentinaFil: Costas Frison, Celeste. No especifíca;Fil: Montenegro, Erica Maricel. No especifíca;Fil: Guzmán, Vilma Roxana. No especifíca;Fil: Donaire, Claudia. No especifíca;Fil: Herrera, Ana Soledad. No especifíca;Fil: Cardozo, Juana Griselda. No especifíca;Fil: Nieva, Nuria Noelia. No especifíca;Fil: Miranda , Ana Lía. Universidad Nacional de Jujuy; ArgentinaFil: Patagua, Patricia Evangelina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Gomez, Carina Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Bustamante, Patricia. Universidad Nacional de Jujuy; ArgentinaFil: Navarro Suárez, Camila. Universidad Nacional de Jujuy; ArgentinaFil: Yufra, Laura Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Massari, María Justina. Universidad Nacional de Jujuy; ArgentinaFil: Cortez, Carla Melisa. Universidad Nacional de Jujuy; ArgentinaFil: Rovetta, Ana Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales; ArgentinaFil: Zinger, Sabrina. Universidad Nacional de Jujuy; ArgentinaFil: Alba, Juan Pablo. Universidad Nacional de Jujuy; ArgentinaFil: Arrueta, Patricia Marisel. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Constant, Juan. Universidad Nacional de Jujuy; ArgentinaFil: Gumiel, Silvina. Universidad Nacional de Jujuy; ArgentinaFil: Zazzarini, Susana. Universidad Nacional de Jujuy; ArgentinaFil: Valente, Verónica. Universidad Nacional de Jujuy; ArgentinaFil: Bergesio, Liliana del Carmen. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: González, Natividad María. Universidad Nacional de Jujuy. Facultad de Ciencias Económicas. Instituto de Investigaciones Económicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Nieva, Florencia Antonella. Universidad Nacional de Jujuy; ArgentinaFil: Callieri, Ivanna Gabriela. Universidad Nacional de Jujuy; ArgentinaFil: Montes, Elena Patricia. Universidad Nacional de Jujuy; ArgentinaFil: Civila Orellana, Fabiola Vanesa. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Villarrubia Gómez, Álvaro Patricio. Universidad Nacional de Jujuy; ArgentinaFil: Quispe, Gloria. Universidad Nacional de Jujuy; ArgentinaFil: Cosme, María Cristina. Universidad Nacional de Jujuy; ArgentinaFil: Quispe, Ariadna Vanesa. Universidad Nacional de Jujuy; ArgentinaFil: Galián, Víctor Joel. Universidad Nacional de Jujuy; ArgentinaFil: Vazquez, Omar Eduardo. Universidad Nacional de Jujuy; ArgentinaFil: Cerpa, Daniela Soledad. Universidad Nacional de Jujuy; ArgentinaFil: Martínez, Luis Gustavo. Universidad Nacional de Jujuy; ArgentinaFil: Fernández, Laura Soledad. Universidad Nacional de Jujuy; ArgentinaFil: Tolaba, Gladys Sarai. Universidad Nacional de Jujuy; ArgentinaFil: Escalante, Norberto Oscar. Universidad Nacional de Jujuy; ArgentinaFil: Cazón, Mariela. Universidad Nacional de Jujuy; ArgentinaFil: Ugarte, María Adela. Universidad Nacional de Jujuy; ArgentinaFil: García Vargas, Alejandra. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Gaona, Melina. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Centro de Estudios de Historia, Cultura y Memoria; ArgentinaFil: Zubia, Gonzalo Federico. Universidad Nacional de Quilmes. Departamento de Ciencias Sociales. Centro de Estudios de Historia, Cultura y Memoria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kulemeyer, Jorge Alberto. No especifíca;Fil: Pantoja, Rodrigo. No especifíca;Fil: Paz, María Elisa. No especifíca;Fil: Rivero, Ariel Rodolfo. No especifíca;Fil: Rocabado, Cecilia Inés. Universidad Nacional de Jujuy; ArgentinaFil: Villagra, Gabriela Soledad. Instituto de Ciencia y Tecnología Regional; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rodríguez, Ana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Ciencia y Tecnología Regional; ArgentinaFil: Adi Barrionuevo, Ana Carolina. Universidad Nacional de Jujuy; ArgentinaFil: Adi Barrionuevo, Irene. Universidad Nacional de Jujuy; ArgentinaFil: Aramayo, Natalia. Universidad Nacional de Jujuy; ArgentinaFil: Fernández, Gabriel. Universidad Nacional de Jujuy; ArgentinaFil: Morales, Miriam Mariana. Universidad Nacional de Jujuy. Instituto de Ecorregiones Andinas. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Ecorregiones Andinas; ArgentinaFil: Rios, Natalia Fatima. Facultad Latinoamericana de Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rocabado, Zaida Nadia. Universidad Nacional de Jujuy; ArgentinaFil: Sandoval, Cecilia. No especifíca;Fil: Soto, Mercedes. No especifíca;Fil: Osores, Noelia Andrea del Valle. No especifíca;Fil: Revollo, Jimena ;Citterio. No especifíca;Fil: Gutiérrez, Ivone Belén. Universidad Nacional de Jujuy; ArgentinaFil: Juste, Stella Maris. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; ArgentinaFil: Vidal, José Fernando. Universidad Nacional de Jujuy; ArgentinaFil: Karasik, Gabriela Alejandra. Universidad Nacional de Jujuy. Facultad de Humanidades y Ciencias Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta; ArgentinaFil: Bruce, Beatriz Maria. Universidad Nacional de Jujuy; Argentin

    Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

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    Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

    Global economic burden of unmet surgical need for appendicitis

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    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 92492millionusingapproach1and92 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 95004millionusingapproach1and95 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

    Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

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    Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ().Results:HighFiO2maybecosteffective(cheaperandeffective).InNigeria,theaveragecostforhighFiO2was). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was 216 compared with 222forlowFiO2leadingtoa 222 for low FiO2 leading to a −6 (95% confidence interval [CI]: −13to 13 to −1) difference in costs. In India, the average cost for high FiO2 was 184comparedwith184 compared with 195 for low FiO2 leading to a −11(9511 (95% CI: −15 to −6)differenceincosts.InSouthAfrica,theaveragecostforhighFiO2was6) difference in costs. In South Africa, the average cost for high FiO2 was 1164 compared with 1257forlowFiO2leadingtoa 1257 for low FiO2 leading to a −93 (95% CI: −132to 132 to −65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this

    Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

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    Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P&lt;0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P&lt;0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally
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