Antibiotic prophylaxis in elective cholecystectomy: Protocol adequacy and related outcomes in a retrospective single-centre analysis.

BACKGROUND: Antibiotic prophylaxis is an effective tool to reduce surgical infection rates. However, antibiotic prophylaxis in cholecystectomy is controversial when non-high risk patients are considered. This research aims to evaluate the adherence with antibiotic prophylaxis protocol in patients undergoing cholecystectomy, and its impact in the outcomes of surgical infection. METHODS: This single-center observational and retrospective study analyzed all elective cholecystectomy procedures carried out at the Fundación Alcorcón University Hospital in the period 2007-2014. Data were recovered from hospital records; rates of adherence to the available hospital protocols were evaluated for choice, initiation, duration, administration route and dosages of antibiotics, and the starting and duration of the prophylaxis. RESULTS: The overall adequacy rate to protocol was 72%. The adherence rates in both the administration route and dose were 100%. The most common violations of the protocol included the choice of antibiotic agent (19%), followed by the moment of initiating its administration (8.9%). The overall wound infection rate was lower in case of laparoscopy than in laparotomy cholecystectomy (1.4% vs. 4.3%, p < 0.05; odds rate [OR] 0.29, 95% confidence interval [CI] 0.1-0.6). No relationship between adequacy of antibiotic prophylaxis and surgical infection rate was documented, neither considering overall gallbladder surgeries (crude OR 0.26, 95% CI 0.1-2.0), nor laparoscopy vs. open surgery (MH adjusted OR 0.24, 95% CI 0.2-2.1). CONCLUSIONS: The overall adequacy rate to antibiotic prophylaxis protocol recommended for elective cholecystectomy in our hospital was high (72%). No significant association between the adequacy or antibiotic prophylaxis and surgical infection was found.

Validity of clinical diagnosis in dermatology.

OBJECTIVE: We evaluated the accuracy of the clinical diagnostic process performed by dermatologists. MATERIAL AND METHODS: We conducted a cross-sectional study, based on a retrospective search of data at a dermatology outpatient department. Fifteen skin diseases were selected. A group of patients with those diseases at their first outpatient visit and a further histopathological study were included. The accuracy of any given clinical diagnosis was studied taking the histopathological diagnosis as the gold standard. Validity indices were calculated. RESULTS: We studied 2188 patients. Skin diseases were more prevalent among women (p < 0.05). While the clinical diagnostic process displayed a high level of validity in melanocytic naevi and basal cell carcinoma, a poor level was nevertheless observed for Bowen's disease (sensitivity 22.8%, specificity 96.5%). The most frequent sites of appearance of dermatological problems were face and trunk. CONCLUSIONS: Evaluation of diagnosis in pathologies having an available "gold standard" enables the accuracy of clinical diagnoses to be verified. The validity of clinical diagnosis was high.