Effectiveness of a preventive bundle of measures for reducing surgical site infections in patients undergoing elective orthopedic procedures in a Hellenic Air Force Hospital.

BACKGROUND: Bundles of preventive measures may improve patient outcomes. The aim of this study is to investigate if a surgical site infections (SSIs) preventive bundle in orthopedic surgery patients can result in reduction of such infections, hospitalization length and cost. METHODS: The present is a retrospective cohort study. A total of 1299 patients was admitted to hospital for an elective orthopedic procedure during 2012-2015. The patients were subjected to either an integrated three-stage SSIs preventive protocol or standard preventive measures. The two groups were compared for incidence of SSIs, median hospitalization length and median cost. RESULTS: The incidence of SSIs was lower in the new-protocol group, when compared to the old protocol one (p=0.102). Median (md) hospitalization length was significantly lower in the new protocol group (md = 2) compared to "old-protocol" group (md= 5) [U = 280520, p<0.001]. Regarding arthroscopies, the median cost in the new protocol patients (md= 1500) was significantly lower compared to "old-protocol" patients (md= 1585) [(U= 112660), p < 0.001]. Knee arthroplasties' median costs did not differ (both mds= 4400, U = 2002, p > 0.05). For hip arthroplasties, the new protocol's patient median cost (md= 3000) was significantly lower than that of "old-protocol" (md = 4000) [U = 19680, p < 0.001]. CONCLUSIONS: The use of a bundle of measures for the prevention of SSIs in a hospital's orthopedic operations proved effective, since it resulted in substantial decrease of SSIs, statistically significant decreased hospitalization length, as well as cost.

"Silent" thrombosis of an abdominal aortic aneurysm not producing acute limb ischemia.

Thrombosis of an abdominal aortic aneurysm is a rare devastating complication with an estimated mortality rate of 50%. Simultaneous acute pain, pallor and coldness of the lower limbs, mottling from the level of iliac crests or umbilicus, paraplegia and absence of femoral pulses are all manifestations of a sudden and acute interruption of blood flow through the aneurysmatic aorta. We report a case of an occlusion of an abdominal aortic aneurysm during hospitalization which was not manifested with symptoms of limb ischemia. In this case we feature the rare and unusually "silent" presentation of the event.

Giant abdominal aortic aneurysms: clinical and technical considerations.

The rupture risk of abdominal aortic aneurysms (AAA) depends primarily on their diameter and increases substantially in large aneurysms. Only a few cases of giant AAAs, with a maximum diameter > 13 cm have been reported in the English literature. This case series report describes 3 cases of giant AAAs presented with rupture. All cases were managed with open surgical repair, since anatomic factors prevented us from choosing an endovascular approach. The huge size of the aneurysm, the short length of the neck and the dislodgement of abdominal organs, that may be densely adhered to its surface with fistula formation, make surgery of this entity very challenging. Open repair of giant AAAs is often the only available treatment, though not always with good results.

Anastomotic pseudoaneurysms: our experience with 49 cases.

We investigated the factors implicated in the pathogenesis of anastomotic aneurysm formation and the postoperative course of patients with such a complication. Forty-five patients with 49 anastomotic aneurysms were diagnosed and treated in two vascular surgery departments in Athens, Greece, during an 8-year period. Emergent complications occurred in 15 cases, rupture in 11, and thromboembolic episodes in another four. Preoperative diagnostic workup in the remaining elective cases (n = 34) included color duplex scan, computed tomographic scan, and angiography. All patients underwent operation, and cultures were obtained during the surgical procedures. Histological examination of the host artery wall adjacent to the aneurysm was also performed. Aortobifemoral bypass was the original operation performed in the majority of cases (71%), and the femoral anastomosis was the most frequent site involved (85.7%). Emergent procedures were associated with increased mortality (46.6%), whereas elective operation resulted in high patency rates and no mortality. In an attempt to isolate predisposing factors that contributed to aneurysm formation, we concluded that the etiology was multifactorial in approximately one-third of the cases and degenerative host artery disease was the main cause (40%). Arterial degeneration is the leading cause of anastomotic aneurysm formation, and emergency arterial reconstruction in cases of aneurysm complication is associated with a poor prognosis.