World journal of surgery
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World journal of surgery · May 2020
Meta AnalysisThe Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis.
Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery. ⋯ Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.
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World journal of surgery · May 2020
Using the World Society of Emergency Surgery (WSES) Triage Tool to Evaluate Timing of Emergency Surgery in Rwanda.
Access to timely and safe emergency general surgery remains a challenge in sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study has the following objectives: (1) to compare the actual time to surgery (aTTS) to the ideal time to surgery among patients undergoing emergency surgery and (2) to explore the use of home to emergency department time (HET) as a new measurement indicator for time from symptoms onset to admission at ED at a referral hospital. ⋯ Our study found that the median aTTS was 7.8 h and most patients (77%) were delayed in having timely surgery after admission at ED. In addition, the median aHET was 2.5 days and most patients (52%) were delayed in reaching the ED. Improving processes to facilitate access and to perform timely emergency surgery through the referral system has a potential to decrease delay and improve outcomes.
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World journal of surgery · Apr 2020
ReviewThe Burden of High-Energy Musculoskeletal Trauma in High-Income Countries.
Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this review is to assess: (1) the current epidemiologic data on the surgical burden of high-energy musculoskeletal trauma in HICs; (2) the current data on the economic impact of high-energy musculoskeletal trauma; and (3) potential strategies for addressing gaps in musculoskeletal trauma care for the future. ⋯ ADDRESSING THE GAPS: While its impact is large, research on musculoskeletal conditions, including high-energy trauma, is underfunded compared to other fields of medicine. An increased awareness among policy makers and healthcare professionals of the importance of care for the high-energy musculoskeletal trauma patient is critical. Full implementation of trauma systems is imperative, and metrics such as the ICD-DALY have the potential to allow for real-time evaluation of prevention and treatment programs aimed to reduce injury-related morbidity and mortality. The dearth in knowledge in optimal and cost-effective post-acute care for high-energy musculoskeletal trauma is a reason for concern, especially since almost half of the costs are attributed to this phase of care. Multidisciplinary rehabilitation teams as part of a musculoskeletal trauma system may be of interest to decrease further the long-term negative effects and the economic burden of high-energy musculoskeletal trauma.
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World journal of surgery · Apr 2020
Observational StudyReoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management.
Bleeding after thyroid and/or parathyroid surgery is a life-threatening emergency. The aim of this study was to determine the rates of reoperation following bleeding, identify risk factors, assess management strategies and outcomes, and develop protocols to reduce risk and improve management of bleeding. ⋯ A higher risk profile for significant post-operative bleeding cannot be determined in patients undergoing thyroid surgery. Based on this experience, we developed protocols to reduce the risk of bleeding (the ITSRED Fred protocol) and for the early detection and management of bleed (the SCOOP protocol) following thyroid and/or parathyroid surgery.
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World journal of surgery · Apr 2020
Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination.
The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination. ⋯ Time to collar removal was significantly greater in a trauma center utilizing a cervical spine clearance protocol based on CTCS. As patients may develop complications related to the collar, future studies should clarify how early removal can be implemented without increasing the risk of morbidity.