RESUMO
This study sets out to compare reconstructive practice between patients undergoing immediate breast reconstruction (IBR) for cancer and those who opted for risk reduction (RR), with an emphasis on examining patterns of secondary surgery. METHODS: Data collection was performed for patients undergoing mastectomy and IBR at a teaching hospital breast unit (2013-2016). RESULTS: In total, 299 patients underwent IBR (76% cancer versus 24% RR). Implant-based IBR rate was similar in both groups (58% cancer versus 63% RR). Reconstruction loss (5.3% cancer versus 4.2% RR) and complication (16% cancer versus 12.9% RR) rates were similar. Cancer patients were more likely to undergo secondary surgery (68.4% versus 56.3%; P = 0.025), including contralateral symmetrization (22.8% versus 0%) and conversion to autologous reconstruction (5.7% versus 1.4%). Secondary surgeries were mostly planned for cancer patients (72% planned versus 28% unplanned), with rates unaffected by adjuvant therapies. This distribution was different in RR patients (51.3% planned versus 48.7% unplanned). The commonest secondary procedure was lipomodeling (19.7% cancer versus 23.9% RR). For cancer patients, complications resulted in a significantly higher unplanned secondary surgery rate (82.5% versus 38.8%; P = 0.001) than patients without complications. This was not evident in the RR patients, where complications did not lead to a significantly higher unplanned surgery rate (58.9% versus 35.2%; P = 0.086). CONCLUSIONS: Most of the secondary surgeries were planned for cancer patients. However, complications led to a significantly higher rate of unplanned secondary surgery. Approximately 1 in 4 RR patients received unplanned secondary surgery, which may be driven by the desire to achieve an optimal aesthetic outcome.
RESUMO
OBJECTIVES: To investigate whether the regular use of alcohol hand gel was having a detrimental effect on hands of healthcare professionals and, if so, to what extent. The study also aimed to establish a link between individuals who felt their hands were suffering from persistent exposure to the gel and those who actively avoided using the gel. DESIGN: A short descriptive questionnaire was distributed to healthcare professionals and those working within clinical areas within one trust (two teaching hospitals). SETTING: Staff that worked or had duties within clinical areas that necessitated the use of alcohol hand gel. PARTICIPANTS: The survey was sent via email to all staff on the email database. MAIN OUTCOME MEASURE: To determine the number of staff that developed new onset skin conditions since the introduction of alcohol hand gel and of what proportion of this number actively or considered avoiding the hand gel. RESULTS: Questionnaires were returned for analysis by 399 respondents. Eighty-eight percent of respondents felt that they had developed new onset skin conditions as a consequence of maintaining hand hygiene protocols. Nurses were the highest users of the hand gel, but interestingly were also the highest group to avoid or consider avoiding the hand gel (52% compared with 28%, 26% and 44% in the doctors, secretaries and healthcare assistants groups, respectively) .Thus indicating more frequent use may cause increased problems. CONCLUSION: This study demonstrated that 88% of respondents stated that they had new-onset skin problems, of which half-felt that alcohol gel was the main contributing factor. There was a detrimental effect on compliance with alcohol gel hand hygiene protocols in this group. This reflects the real life difficulties of staff in their endeavour to reduce hospital-acquired infections. Action is needed to improve the compliance with such a simple task and ensure that all is done to reduce nosocomial infection and reduce the potential financial burden.
