Glycosylated hemoglobin level in patients with and without surgical site infection after hysterectomy.

BACKGROUND: Surgical site infection (SSI) occurs in 11-12% of surgeries. The glycosylated hemoglobin (HbA1c) has been found to be significantly elevated in those who presented infection. OBJECTIVE: To compare the concentration of HbA1c between patients with and without SSI after hysterectomy. METHOD: In healthy, postoperative women with total abdominal (open) hysterectomy, the HbA1c serum concentration was measured (normal <5.7%) and the difference between those who presented SSI and other risk factors for SSI were compared with Mann Whitney U test was used. The HbA1c values were stratified as normal or abnormal and were contrasted with the presence or absence of SSI by means of X2. RESULTS: 27 women without SSI and 20 with SSI were studied. The preoperative glucose was and 88 (70-99) mg/dl and 86 (70-99) mg/dl for the groups with and without SSI respectively. The HbA1c was significantly higher in the group with ISQ 5.6% (5-8) vs. 6.5% (5.2-8.2). The sensitivity of HbA1c with cut point <5.7 was 80% and the specificity was 51.9%. CONCLUSION: HbA1c can serve as a prognostic criterion of ISQ.

ANTECEDENTES: La infección del sitio quirúrgico (ISQ) se presenta en el 11-12% de las cirugías. La hemoglobina glucosilada (HbA1c) se ha encontrado significativamente elevada en los pacientes que presentan infección. OBJETIVO: Comparar la concentración de HbA1c entre pacientes con y sin ISQ posterior a una histerectomía. MÉTODO: En mujeres sanas posoperadas de histerectomía total abdominal (abierta) se midió la concentración sérica de HbA1c (normal < 5.7%) y se comparó la diferencia entre las que presentaron ISQ y las que no. Se investigaron también otros factores de riesgo para ISQ. Se utilizó la prueba U de Mann Whitney. Los valores de HbA1c se estratificaron como normales o anormales, y se contrastaron con la presencia o no de ISQ por medio de la prueba ji al cuadrado. RESULTADOS: Se estudiaron 27 mujeres sin ISQ y 20 con ISQ. La glucosa preoperatoria fue de 88 (70-99) y 86 (70-99) mg/dl para los grupos con y sin ISQ, respectivamente. La HbA1c fue significativamente mayor en el grupo con ISQ (5.6%; 5-8) que en el grupo sin ISQ (6.5%; 5.2-8.2). La sensibilidad de la HbA1c con un punto de corte < 5.7 fue del 80% y la especificidad fue del 51.9%. CONCLUSIÓN: La HbA1c puede servir como criterio pronóstico de ISQ.

Role of Imaging, Tissue Sampling, and Biomarkers for Diagnosis of SSI in Spine Surgery.

In July 2018, the Second International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia, PA to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 15 focused on the use of imaging, tissue sampling, and biomarkers in spine surgery, for which this article provides the recommendations, voting results, and rationales.

Preoperative serum albumin as a predictor of complications following total hip replacement in patients with rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease characterized by polyarthritis with progressive articular wear, immunologic abnormalities and increasing physical limitation. Surgical correction with hip replacement comes as a successful solution for patients with advanced articular destruction. Following intervention, surgical site infection (SSI), venous thromboembolism, sepsis, renal and major cardiovascular complications are among the most cited in the literature. No consensus exists as to the detection of preoperative hypoalbuminemia in patients with rheumatoid arthritis. METHODS: This study retrospectively evaluated the preoperative serum albumin of 75 patients with rheumatoid arthritis and analyzed its relevance in terms of appearance of postoperative complications with a six-month follow-up. Complications in the group of patients with low serum albumin and the group of patients with normal serum albumin were reviewed to identify the effect of each variable. Odds ratio for each variable was calculated (hospital readmission, surgical site infection, renal and cardiac complications, non-infectious wound complications and the presence of residual hip pain), as well as p-value and confidence intervals. RESULTS: Surgical site infection showed a statistically significant relation with low serum albumin (OR: 6.125, p = 0.018) as did non-infectious wound complications (OR: 3.714, p = 0.026) and residual hip pain (OR: 3.149, p = 0.022). CONCLUSION: Preoperative low serum albumin has a direct relation with the rate of postoperative complications including SSI, non-infectious wound complications (seroma formation, wound dehiscence) and residual hip pain. Preoperative serum albumin is a reliable marker of nutrition, which may establish preventive strategies to reduce postoperative complications in patients with rheumatoid arthritis.

INTRODUCCIÓN: La artritis reumatoide es una enfermedad inflamatoria crónica con desgaste articular progresivo, anomalías inmunológicas y aumento de la limitación física. La corrección quirúrgica con el reemplazo de la cadera es una solución a la destrucción articular avanzada. Después de la intervención, la infección del sitio quirúrgico (SSI), el tromboembolismo venoso, la sepsis y las complicaciones cardiovasculares o renales se encuentran entre las más citadas en la literatura. No existe consenso en cuanto a la detección de hipoalbuminemia preoperatoria en pacientes con artritis reumatoide. MÉTODOS: Estudio retrospectivo evaluando la albúmina de suero preoperatoria de 75 pacientes con artritis reumatoide, se analizó su importancia en términos de complicaciones postoperatorias en los primeros seis meses de seguimiento. Las complicaciones en el grupo de pacientes con albúmina de suero baja y el grupo de pacientes con albúmina de suero normal fueron repasadas para identificar el efecto de cada variable. Se calculó el odds ratio para cada variable (reingreso hospitalario, infección del sitio quirúrgico, complicaciones renales y cardíacas, complicaciones no infecciosas de la herida y presencia de dolor de cadera residual), así como el valor p y los intervalos de confianza. RESULTADOS: La infección del sitio quirúrgico demostró una relación estadística significativa con la albúmina de suero baja (o: 6.125, p = 0.018) al igual que complicaciones no infecciosas de la herida (o: 3.714, p = 0.026) y dolor residual de la cadera (o: 3.149, p = 0.022). CONCLUSIÓN: La albúmina sérica baja preoperatoria tiene una relación directa con la tasa de complicaciones postoperatorias: infección, formación de seromas, dehiscencia de la herida y dolor residual.

Preoperative serum albumin as a predictor of complications following total hip replacement in patients with rheumatoid arthritis / Albúmina sérica preoperatoria como un predictor de complicaciones posterior al reemplazo total de cadera en pacientes con artritis reumatoide

Abstract: Background: Rheumatoid arthritis is a chronic inflammatory disease characterized by polyarthritis with progressive articular wear, immunologic abnormalities and increasing physical limitation. Surgical correction with hip replacement comes as a successful solution for patients with advanced articular destruction. Following intervention, surgical site infection (SSI), venous thromboembolism, sepsis, renal and major cardiovascular complications are among the most cited in the literature. No consensus exists as to the detection of preoperative hypoalbuminemia in patients with rheumatoid arthritis. Methods: This study retrospectively evaluated the preoperative serum albumin of 75 patients with rheumatoid arthritis and analyzed its relevance in terms of appearance of postoperative complications with a six-month follow-up. Complications in the group of patients with low serum albumin and the group of patients with normal serum albumin were reviewed to identify the effect of each variable. Odds ratio for each variable was calculated (hospital readmission, surgical site infection, renal and cardiac complications, non-infectious wound complications and the presence of residual hip pain), as well as p-value and confidence intervals. Results: Surgical site infection showed a statistically significant relation with low serum albumin (OR: 6.125, p = 0.018) as did non-infectious wound complications (OR: 3.714, p = 0.026) and residual hip pain (OR: 3.149, p = 0.022). Conclusion: Preoperative low serum albumin has a direct relation with the rate of postoperative complications including SSI, non-infectious wound complications (seroma formation, wound dehiscence) and residual hip pain. Preoperative serum albumin is a reliable marker of nutrition, which may establish preventive strategies to reduce postoperative complications in patients with rheumatoid arthritis.

Resumen: Introducción: La artritis reumatoide es una enfermedad inflamatoria crónica con desgaste articular progresivo, anomalías inmunológicas y aumento de la limitación física. La corrección quirúrgica con el reemplazo de la cadera es una solución a la destrucción articular avanzada. Después de la intervención, la infección del sitio quirúrgico (SSI), el tromboembolismo venoso, la sepsis y las complicaciones cardiovasculares o renales se encuentran entre las más citadas en la literatura. No existe consenso en cuanto a la detección de hipoalbuminemia preoperatoria en pacientes con artritis reumatoide. Métodos: Estudio retrospectivo evaluando la albúmina de suero preoperatoria de 75 pacientes con artritis reumatoide, se analizó su importancia en términos de complicaciones postoperatorias en los primeros seis meses de seguimiento. Las complicaciones en el grupo de pacientes con albúmina de suero baja y el grupo de pacientes con albúmina de suero normal fueron repasadas para identificar el efecto de cada variable. Se calculó el odds ratio para cada variable (reingreso hospitalario, infección del sitio quirúrgico, complicaciones renales y cardíacas, complicaciones no infecciosas de la herida y presencia de dolor de cadera residual), así como el valor p y los intervalos de confianza. Resultados: La infección del sitio quirúrgico demostró una relación estadística significativa con la albúmina de suero baja (o: 6.125, p = 0.018) al igual que complicaciones no infecciosas de la herida (o: 3.714, p = 0.026) y dolor residual de la cadera (o: 3.149, p = 0.022). Conclusión: La albúmina sérica baja preoperatoria tiene una relación directa con la tasa de complicaciones postoperatorias: infección, formación de seromas, dehiscencia de la herida y dolor residual.

[Absence of bacteremia after dental extractions]. / Inexistencia de bacteriemia consecutiva a la odontectomía

A study was made on 100 subjects of both sexes between the ages of 3 and 15 years to detect the presence of bacteria in the circulation after performing dental extractions. Two groups were formed of 42 and 57 subjects respectively. One of these groups was subjected to preoperative antisepsis of the region to be operated on, the rest of the conditions were similar for both groups. All the patients were submitted to a preoperative gingival smear and 5 c.c. of blood taken for cultures. Two postoperative blood cultures, one immediately after the operations and another 24 hrs. later were also done in all patients. All the extracted teeth presented severe infections at the root level and some showed complicated infection such as osteomyelitis. All blood cultures performed 24, 48, 72 hrs. and 21 days after the operation, were negative; therefore, there is no justification based on the study, to assume the existance of focal infection related to the presence of bacteremia.