Prevention of complications of iatrogenic transient bacteremia in dental practice

The aim of the work was to develop an algorithm of anti-microbial chemotherapy for the perioperative prevention of local inflammatory complications. To clarify the data on possible pathogens of postoperative local inflammatory complications, the authors conducted their own microbiological studies to determine the microbiome of an operating wound under the conditions of aerobic and anaerobic cultivation of inoculum with subsequent identification by a complex of morphological, cultural and biochemical properties. Periodontal pathogens were identified by PCR. The microbiome of the surgical wound was analyzed for conditionally clean wounds (group 1 — 61 patients after dental implantation surgery), infected (group 2-41 patients with a diagnosis of pericoronitis, difficult eruption of the wisdom tooth) and contaminated (group 3 — 42 patients after cystectomy, granulomectomy). Based on the literature data and the results of our own research, an algorithm of antimicrobial chemotherapy (prevention) for outpatient operations in dental practice has been developed. The algorithm includes the most commonly used drugs by dentists, taking into account the microbiota of the postoperative wound, the sensitivity of pathogens to antibiotics, and the duration of treatment courses.

Prevention of complications of iatrogenic transient bacteremia in dental practice

The aim of the work was to develop an algorithm of anti-microbial chemotherapy for the perioperative prevention of local inflammatory complications. To clarify the data on possible pathogens of postoperative local inflammatory complications, the authors conducted their own microbiological studies to determine the microbiome of an operating wound under the conditions of aerobic and anaerobic cultivation of inoculum with subsequent identification by a complex of morphological, cultural and biochemical properties. Periodontal pathogens were identified by PCR. The microbiome of the surgical wound was analyzed for conditionally clean wounds (group 1 — 61 patients after dental implantation surgery), infected (group 2-41 patients with a diagnosis of pericoronitis, difficult eruption of the wisdom tooth) and contaminated (group 3 — 42 patients after cystectomy, granulomectomy). Based on the literature data and the results of our own research, an algorithm of antimicrobial chemotherapy (prevention) for outpatient operations in dental practice has been developed. The algorithm includes the most commonly used drugs by dentists, taking into account the microbiota of the postoperative wound, the sensitivity of pathogens to antibiotics, and the duration of treatment courses.

The efficiency of radiowave technology in out-patient eye surgery

Purpose: to analyze the technique of outpatient operations using radiowave surgery.Material and methods. The clinical group of 691 patients (691 eyes; 315 men and 376 women aged 39.7 ± 4.2 years), with various pathologies of the eye and adnexa, in particular papilloma, eyelid cyst, abscess, chalazion, contagious mollusk, pterygium, pinguecula, conjunctival cyst, trichiasis, xanthelasma were observed for 2 years. Surgical treatment of adnexa neoplasms was performed using a Surgitron radiowave apparatus (USA) in three modes.Results. Multiple techniques of radiowave surgery targeting specific eye and adnexa pathologies are presented. Using electrodes of varied configurations enables the application of radio knives practically in all ophthalmoplastic surgeries belonging to “minor surgery”. The presence of flexible microwires on electrodes with changeable shapes contributes to improved surgery results.Conclusion. Radiowave technique of cutting and coagulation with the help of a radio knife not only reduces the time required for surgery but increases the convenience for the surgeon performing individual stages of the operation, or the whole operation. The disinfecting properties of the tips emerging due to the action of radiowaves help prevent the relapses of diseases and reduce the time of wound rehabilitation, thereby improving the cosmetic effect of the intervention.

Do Patients With Inflammatory Bowel Disease Benefit from an Enhanced Recovery Pathway?

Background Enhanced recovery pathways (ERPs) have been shown to reduce length of stay (LOS), complications, and costs after colorectal surgery; yet, little data exists regarding patients with inflammatory bowel disease (IBD). We hypothesized that implementation of ERP for IBD patients is associated with shorter LOS and improved economic outcomes. Methods An IRB-approved prospective clinical database was used to identify consecutive patients from 2015 to 2017. Patients were grouped as “pre-ERP” and “post-ERP” based on the date of implementation of a comprehensive ERP. Ileostomy closures, redo pouch operations, and outpatient operations were excluded. The relationship between ERP, LOS, and secondary outcomes was assessed using univariate and multivariate analysis. Results Overall, a total of 671 patients were included: 345 (51.4%) with Crohn’s disease (CD) and 326 (48.6%) with ulcerative colitis (UC). Of these, 425 were pre-ERP (63.4%), and 246 were post-ERP (36.6%). The groups did not differ in terms of age, gender, American Society of Anesthesiologist (ASA) scores, comorbidities, estimated blood loss, or ostomy construction. The post-ERP group had a significantly higher mean body mass index (BMI), more patients with CD, longer operative time, and more minimally invasive surgery (MIS; all P < 0.05). The post-ERP group had a significantly shorter LOS (6 vs 4.5 days, median), whereas mean hospital costs decreased by 15.7%. There was no difference in readmissions or complications. On multivariate analysis, MIS and ERP use were both associated with a shorter LOS. Conclusion Inflammatory bowel disease patients benefit from the use of ERP, demonstrating decreased LOS and costs without an increase in complications and readmissions. Enhanced recovery pathways should be routinely implemented in this often challenging patient population.

Outpatient Parathyroid Surgery: Ten-Year Experience: Is it Safe?

Outpatient parathyroid surgery is increasing in frequency especially for patients undergoing minimally invasive operations. From January 1, 2000 to December 31, 2009, 585 operations were performed on patients with untreated primary hyperparathyroidism. Outpatient operations were performed on 43 per cent (249/585), whereas 57 per cent (336/585) were admitted. Comorbidities were present in 63 per cent of outpatients and 72 per cent of inpatients, whereas systemic complications occurred in 0.8 per cent of outpatients and 7 per cent of inpatients. Ninety-four per cent of outpatients were minimally invasive although inpatient procedures were evenly divided. Local complications were low (8% and 6%) in both groups. Using zip codes to determine distance from home to hospital, no differences were noted. Readmission rates were low (< 0.5%) and the same in each group. Inpatients longer than 23 hours tended to be older with higher local and systemic complication rates. Over a decade, most patients undergoing same day parathyroid surgery had minimally invasive operations with lower comorbidities and lower systemic complications than inpatients. Minimally invasive and less complex nonminimally invasive operations can safely be performed on an outpatient basis with careful patient selection. Patient with more severe comorbidities and multiple comorbidities are less favorable candidates for outpatient surgery because of a higher risk of systemic complications.