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PLoS One ; 16(8): e0254698, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34383776


BACKGROUND: Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients. METHODS: A decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves. RESULTS: In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds. CONCLUSIONS: Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an urgent need for a robust clinical trial on the intervention on non-cardiac surgery.

Abdome/cirurgia , Clorexidina/uso terapêutico , Modelos Teóricos , Pneumonia/prevenção & controle , COVID-19 , Análise Custo-Benefício , Humanos , Antissépticos Bucais , Pandemias , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Estudos Prospectivos , África do Sul
ANZ J Surg ; 87(10): 780-783, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27581039


BACKGROUND: Pull-through of ganglionic bowel is essential for successful treatment of Hirschsprung's disease. We studied the incidence of transition zone pull-through in our institution and compared its outcome with ganglionic bowel pull-through. METHODS: Children who underwent Soave's pull-through for Hirschsprung's disease from January 2005 to November 2012 were studied. Patients were divided into two groups: ganglionic bowel pull-throughs (Group 1) and transition zone pull-throughs (Group 2). Demographics, presentations, surgical procedure, post-operative results and complications including redo procedures were recorded and reviewed along with histopathology reports. RESULTS: Fifty patients underwent Soave's pull-through for Hirschsprung's disease in our group. The median age at surgery was 13.5 days in Group 1 and 22.5 days in Group 2. Transition zone pull-through occurred in eight children (16%). Transition zone pull-through was attributed to errors in histologic interpretation (n = 5), sampling (n = 2) and surgical technique (n = 1). The transition zone was significantly longer in Group 2 (P = 0.002). Constipation and enterocolitis were the main complications needing therapy. One child in Group 2 required surgery for adhesive intestinal obstruction. CONCLUSIONS: The length of the transition zone in children with transition zone pull-through was significantly longer. Though our children with transition zone pull-through did not require redo surgery the possibility of redo surgery remains. Transition zone pull-through should still be considered an error and should be prevented.

Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doença de Hirschsprung/patologia , Doença de Hirschsprung/cirurgia , Erros Médicos/prevenção & controle , Reto/cirurgia , Constipação Intestinal/epidemiologia , Constipação Intestinal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Enterocolite/epidemiologia , Enterocolite/etiologia , Feminino , Doença de Hirschsprung/complicações , Doença de Hirschsprung/epidemiologia , Humanos , Incidência , Recém-Nascido , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Reto/inervação , Reto/patologia , Reoperação/estatística & dados numéricos , Centros de Atenção Terciária , Resultado do Tratamento