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Become a member and receive career-enhancing benefits
Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.
Susan Feldt and coauthors conducted a single-center retrospective study of patients who had undergone two separate abdominal surgical procedures in 2012–2018; the study included 758 patients. Postoperative surgical site infections (SSI) occurred in 15% of patients following the first operation and in 9.5% of the total cohort after the second operation. SSI was diagnosed in 22.8% of patients who had been diagnosed with SSI after the first procedure. Bacterial culture data showed that causative organisms in SSI following the second operation were more likely to be resistant to antibiotics used for perioperative prophylaxis; nearly half of the infections were caused by organisms that were resistant to these agents.
The authors concluded that SSI following an initial procedure was a risk factor for SSI after a second operation and encouraged further studies to evaluate ways to detect and predict patterns of infection with resistant organisms so that targeted antimicrobial prophylaxis can be effective for preventing SSI.
In the editorial that accompanied this report, Casey Silver, MD, and Ryan Merkow, MD, MS, emphasized the importance of gathering data regarding whether antimicrobial prophylaxis is being used in ways that minimize the risk for developing antimicrobial resistance. They also noted that antimicrobials used for infections other than SSI (for example, urinary tract infections) also may contribute to development of resistance. They concluded that a coordinated approach will be needed for each hospital so that appropriate prophylaxis can be documented and development of resistance can be minimized.
Telemedicine Consultation Beneficial for Rural Patients Referred for Abdominal Wall Reconstruction and Hernia Repair
This report described the effects of a telehealth program specifically designed for preoperative assessment and postoperative care of surgical patients undergoing abdominal wall reconstruction and hernia repair procedures. The included patients lived in rural areas remote from the hospital where the surgical procedure was performed. The median distance from the hospital was nearly 300 km (approximately 186 miles).
Outcomes in patients living remotely were compared with patients residing near the treating hospital. The study cohort included 373 telehealth encounters. The data analysis showed significant benefits in terms of reduced travel time, expense, and inconvenience. Need for in-person postoperative visits and interventions was 6.1%, and this was similar for patients living near the hospital where the procedure was performed or living in a rural area away from the treating institution. The authors concluded that despite an increased burden of comorbid conditions in patients living remotely in rural areas, telehealth was useful for preoperative and postoperative management of this group.
Examining Nonoperative versus Surgical Repair in Acute Achilles Tendon Rupture
The authors reported results of a multicenter randomized trial comparing outcomes of surgical management of acute Achilles tendon rupture with nonoperative management; the study cohort included 526 patients. Supervised physical therapy and especially designed orthotic devices were used for both groups. Outcomes were quantified using the Achilles tendon total rupture score.
Improvements in scores were similar for patients treated nonoperatively, with open surgical repair, and minimally invasive surgical repair. Tendon re-rupture occurred in 6.2% of the nonoperative group compared to a 0.6% re-rupture rate in both operative groups. Data on characteristics and risk factors for re-rupture for patients in the nonoperative group were not reported.
In the accompanying editorial, Kristoffer W. Barfod, MD, PhD, and Per Hölmich, DMSc, noted that no available treatment of Achilles tendon rupture is superior based on available data; success rates approach 95% for all treatment approaches. They stressed the importance of determining risk factors for re-rupture that could improve patient selection for surgical repair.
