Radiological incidence of donor-site incisional hernia and parastomal hernia after vertical rectus abdominus myocutaneous flap-based reconstruction following colorectal surgery.

AIM: A vertical rectus abdominis myocutaneous (VRAM) flap is commonly used to reconstruct perineal defects for low rectal and anal cancer. The incidence of midline incisional hernias after VRAM reconstruction varies from 3.6% when detected clinically to 50% when detected radiologically. The aim of this study is to accurately determine the radiological incidence of donor-site incisional and parastomal hernia following VRAM reconstruction. METHOD: This was a retrospective cohort study of patients undergoing colorectal surgery requiring VRAM reconstruction over 10 years. Data were collected on patient demographics, indication for surgery and surgical procedure, including details of any hernia repair. Images from surveillance CTs were reviewed for the presence and size of midline incisional and/or parastomal hernias. Parastomal hernias were classified based on the European Hernia Society (EHS) classification. RESULTS: One hundred and seventy three patients were included in the analysis. The median age was 67 years (range 29-88 years) and the median length of follow-up was 49 months (interquartile range 24.3-71.0 months). The cumulative incidence of donor-site incisional hernia after VRAM at 1, 2 and 5 years was 15.1%, 25.4% and 29.1%, respectively. The cumulative incidence for PSH at 1, 2 and 5 years was 33.1%, 46.6% and 53.3%, respectively (95% CI 45.4%-60.5%). CONCLUSION: Most patients who develop donor-site incisional hernia and parastomal herniation following VRAM tend to do so within the first 2 years. Although the use of CT imaging improves the diagnosis of donor-site incisional and parastomal hernias, the clinical significance of this is unknown.

Altmetric Versus Bibliometric Perspective Regarding Publication Impact and Force.

BACKGROUND: Bibliometric and Altmetric analyses highlight key publications, which have been considered to be the most influential in their field. The hypothesis was that highly cited articles would correlate positively with levels of evidence and Altmetric scores (AS) and rank. METHODS: Surgery as a search term was entered into Thomson Reuter's Web of Science database to identify all English-language full articles. The 100 most cited articles were analysed by topic, journal, author, year, institution, and AS. RESULTS: By bibliometric criteria, eligible articles numbered 286,122 and the median (range) citation number was 574 (446-5746). The most cited article (Dindo et al.) classified surgical complications by severity score (5746 citations). Annals of Surgery published most articles and received most citations (26,457). The country and year with most publications were the USA (n = 50) and 1999 (n = 11). By Altmetric criteria, the article with the highest AS was by Bigelow et al. (AS = 53, hypothermia's role in cardiac surgery); Annals of Surgery published most articles, and the country and year with most publications were USA (n = 4) and 2007 (n = 3). Level-1-evidence articles numbered 13, but no correlation was found between evidence level and citation number (SCC 0.094, p = 0.352) or AS (SCC = 0.149, p = 0.244). Median AS was 0 (0-53), and in articles published after the year 2000, AS was associated with citation number (r = 0.461, p = 0.001) and citation rate index (r = 0.455, p = 0.002). AS was not associated with journal impact factor (r = 0.160, p = 0.118). CONCLUSION: Bibliometric and Altmetric analyses provide important but different perspectives regarding article impact, which are unrelated to evidence level.

Sharps and needlestick injuries within the operating room: Risk prone procedures and prevalence meta-analysis.

BACKGROUND: Sharps and needlestick injuries pose a serious risk to operating theatre personnel with considerable morbidity, mortality and healthcare implications. The cost of prophylaxis and post-exposure treatment is a significant institutional economic burden. AIM: The aim of the review was to identify the prevalence of sharps and needlestick injury within the operating theatre and to establish the most common critical steps. METHOD: A systematic literature search was conducted. Abstracts of all studies published in English from 2015 onwards exploring sharps and needlestick injury within the operating theatre were reviewed. Primary outcome measure was sharps and needlestick injury prevalence. Secondary outcome measures included operational steps resulting in sharps and needlestick injury and costs of sharps and needlestick injury management. RESULTS: Sixteen studies were identified and included in analysis. Cross-sectional studies reported a pooled prevalence of 41.5% (n = 537; 95% confidence interval = 15.961 to 70.220). Retrospective data analysis reported an annualised prevalence of 5.027% (95% confidence interval = 0.676 to 13.073) on a total pooled sample population of 12,929. Further analysis of operational steps identified a 22% prevalence (n= 3460; 95% confidence interval = 14.2 to 31.3) of sharps and needlestick injury occurring during a procedure involving handing or receiving an instrument. CONCLUSION: Sharps and needlestick injuries are a significant but preventable risk in the operating theatre. Further research into the development of safety devices to reduce injury during instrument transfer is paramount.