Antibiotic Prophylaxis Guideline Awareness and Antibiotic Prophylaxis Use Among New York State Dermatologic Surgeons

BACKGROUND: Use of antibiotic prophylaxis in dermatologic surgery patients remains controversial and several sets of guidelines exist. OBJECTIVE: We investigated dermatologic surgeon's awareness of the American Heart Association (AHA) 1997 antibiotic prophylaxis guidelines, their use of prophylactic antibiotics, and their practices as compared with the Haas and Grekin's 1995 antibiotic prophylaxis guidelines. METHODS: We mailed postage-paid questionnaires regarding AHA guideline awareness and antibiotic prophylaxis use to the 235 New York State members of the American Society for Dermatologic Surgery (ASDS). We received 87 replies. RESULTS: Most participants recognize AHA guidelines and claim to follow them. We reiterate previous studies' findings. Most dermatologic surgeons use antibiotics appropriately. However, antibiotics are occasionally overused or dosed outside the guidelines. Many participants prescribe antibiotics based on a patient's other physicians' recommendations. Notably, erythromycin is sometimes used, an antibiotic the AHA no longer recommends. CONCLUSION: Dermatologic surgeons commonly use antibiotic prophylaxis to prevent bacterial endocarditis. Based on previous studies, though, the risk of endocarditis following cutaneous surgery is low and thus the use of antibiotic prophylaxis is controversial. Although this practice is appropriate for high-risk patients when skin is contaminated, it is not recommended for noneroded, noninfected skin. We report that dermatologists may be aware of the guidelines, but only seem to partially follow them. Further studies are still needed to establish optimal guidelines.     

Practice Patterns of Antibiotic Prophylaxis in Patients Undergoing Mastectomy: A Survey of Members of the American Society of Breast Surgeons

Annals of Surgical Oncology - Surgical site infections after breast surgery range from 1 to 16%. Both the American Society of Breast Surgeons (ASBrS) and the American Association of Plastic...     

National Practice Patterns in Preoperative and Postoperative Antibiotic Prophylaxis in Breast Procedures Requiring Drains: Survey of the American Society of Breast Surgeons

Background

To assess national practice patterns regarding use of perioperative antibiotics by surgeons performing breast operations requiring drainage tubes.

Methods

The members of the American Society of Breast Surgeons (ASBrS) were surveyed regarding use of perioperative antibiotics for breast operations requiring drains, with or without immediate tissue expander or implant reconstruction.

Results

Of 2,857 ASBrS members contacted, 917 (32?%) responded; all self-identified as surgeons. Of 905 evaluable respondents, most described themselves as general surgeons (46?%) or breast surgeons (46?%). For cases in which drains are anticipated, most respondents (86?%) reported routine use of preoperative prophylactic antibiotics, with 99?% selecting cephalosporins. Use of antibiotic >24?h postoperatively varied by whether or not reconstruction was performed. In nonreconstruction cases, the majority (76?%) reported ??never/almost never?? prescribing antibiotics beyond the 24-h postoperative period, but 16?% reported ??always/almost always.?? In reconstruction cases, the majority (58?%) reported routine antibiotic use beyond 24?h, and the primary driver of the decision to use antibiotics was reported to be the plastic surgeon (83?%). Among those reporting use at >24?h, the duration recommended for nonreconstruction cases was ??up to 1?week?? in 38?% and ??until drains removed?? in 39?%; this was similar for reconstruction cases.

Conclusions

Cephalosporins are utilized uniformly as preoperative antibiotic prophylaxis in breast operations requiring drains. However, use of postoperative antibiotic prophylaxis is strongly dependent on the presence of immediate breast reconstruction. Consensus is lacking on the role of postoperative antibiotic prophylaxis in breast operations utilizing drains.     

Antibiotic Prophylaxis for Dental Procedures at Risk of Causing Bacteremia Among Post-Total Joint Arthroplasty Patients: A Survey of Canadian Orthopaedic Surgeons and Dental Surgeons

To elicit current practice and attitudes toward use of antibiotic-prophylaxis among TJA patients prior to dental procedures, a cross-sectional survey of practicing Canadian orthopaedic (OS) and dental surgeons (DS) was undertaken. Of respondents, 77% of OS and 71% of DS routinely prescribe antibiotic-prophylaxis, but while 63% of OS advocate lifelong use, only 22% of DS choose to do so (P < 0.0001). Both groups nonetheless recognize the importance of treatment within 2-years post-TJA as per AAOS/ADA guidelines. However, greater duration of practice pointed to potential inadequacy of these guidelines based on reported experience with late-hematogenous infection post-TJA. While discrepancies in attitude toward antibiotic-prophylaxis between surgeon groups remain, both groups agreed that the evidence to support decision making regarding antibiotic-prophylaxis for TJA patients undergoing dental procedures remains inadequate.     

Hemodialysis Use and Practice Patterns: An International Survey Study

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Neuromonitoring in Thyroid Surgery: Attitudes,Usage Patterns,and Predictors of Use Among Endocrine Surgeons

Background  The use of neuromonitoring in thyroid surgery is controversial. Attitudes about neuromonitoring, usage patterns, and predictors of use have not been formally studied. We hypothesized that attitudes would predict usage patterns and that the predominant strategy among endocrine surgeons would be no neuromonitoring during thyroid surgery. Methods  Members of the American Association of Endocrine Surgeons and registrants of the 2006 annual meeting were surveyed by e-mail. An Internet-based survey composed of simple answer and Likert questions was used. Central tendency was evaluated by modal response. Significance was analyzed by the chi-squared test, and strength of association was calculated by Cramér’s V. Results  A total of 117 surveys were completed (41%). Respondents were placed into two groups based on use (37.1%), or nonuse (62.9%) of neuromonitoring. The use category was composed of routine (13.8%) and selective (23.3%) users. The nonuse category was composed of those who have never used neuromonitoring (49.1%) and those who have abandoned its use (13.8%). Nonusers were older (p = 0.023) and reported a lower case volume (p = 0.003), less familiarity with the technology (p < 0.001), and less access to the equipment (p < 0.001). Nonusers reported a lower frequency of patient-initiated discussions about neuromonitoring (p < 0.001) and were less likely to initiate a discussion with patients (p < 0.001). In total, 56% of users and 90% of nonusers believed neuromonitoring does not improve the safety of thyroidectomy (p < 0.01). There was no difference in perceived nerve injury rate between users and nonusers. Users agreed that benefits include facilitating identification of the recurrent laryngeal nerve, facilitating resident education, improving patient outcomes, and decreasing liability risk, whereas nonusers disagreed with these statements. Nonusers believed that neuromonitoring can lead to reliance on technology and loss of surgical technique or judgment, but users disagreed. There was consensus of opinion that neuromonitoring allows identification of an intact nerve, can lead to a false sense of security, drives up costs, is beneficial in <10% of cases, does not shorten the length of the procedure, and does not prevent nerve injury. Conclusions  Usage is associated with surgeon age, case volume, equipment availability and familiarity, beliefs about the degree of benefit, and frequency of patient or doctor initiated discussions.     

Incidental Parathyroidectomy during Thyroid Surgery: An Underappreciated Complication of Thyroidectomy

The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. Prospective analysis of data in patients following thyroidectomy, specifically regarding the presence of parathyroid parenchyma in the thyroidectomy specimens, the underlying thyroid pathology, and the presence of postoperative hypocalcemia (biochemical/clinical). The clinical records of 158 patients who underwent thyroid surgery during a 2-year period were reviewed. Pathology reports were carefully reviewed for the nature of the underlying thyroid disease, the presence, number, and size of incidentally resected parathyroid gland(s), their location, and possible parathyroid pathology. Serum calcium levels were measured preoperatively, on the day of surgery, and on postoperative days 1, 2, and 7 or even later as needed. Two groups of patients were studied: a group with incidental parathyroidectomy following thyroidectomy (group A) and a group without incidental parathyroidectomy after thyroidectomy (group B). Total/near-total thyroidectomy was the procedure of choice and was performed in 154 patients; total lobectomy and contralateral subtotal lobectomy was performed in the other 4 patients. Elective central neck lymph node dissection was performed in four patients with neck lymphadenopathy. Inadvertently removed parathyroid tissue was found in 28 cases (17.7 %); in 6 of these patients (21%) the parathyroid tissue was intrathyroidal. The percentage of women in group A was significantly higher than in group B (93% vs. 58.5%, P = 0.0002). There was no statistically significant difference between the two groups (A and B) regarding the preoperative (presumed) diagnosis, the histologic diagnosis of thyroid disease (benign versus malignant), the type/extent of surgery, or the presence of thyroiditis. Biochemical and clinical hypocalcemia was observed in 6 (21%) and 2 (7%) patients in group A, respectively, and in 30 (23%) and 8 (6%) patients of group B, respectively. There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia (clinical/biochemical) between the two groups (P = 0.33). Incidental parathyroidectomy is not uncommon following thyroidectomy and in a significant percentage of cases it may be due to the intrathyroidal location of the parathyroid glands. Incidental parathyroidectomy was not found to be associated with postoperative hypocalcemia (biochemical/clinical). Incidental parathyroidectomy may be considered as a potentially preventable but clinically minor complication of thyroid surgery.     

Childbearing After Hyperthermic Intraperitoneal Chemotherapy: Results From an International Survey

Background  

Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) can improve survival in selected patients with primary or secondary peritoneal malignancies. With the opportunity for long-term survival, questions about the impact of those procedures in fertility in women of childbearing age can be raised.     

Practice Patterns in Parathyroid Surgery: A Survey of Asia-Pacific Parathyroid Surgeons

World Journal of Surgery - Practice variations exist amongst parathyroid surgeons depending on their expertise and resources. Our study aims to elucidate the choice of surgical techniques and...     

Use of Ligasure in Thyroidectomy Procedures: Results of a Prospective Comparative Study

The thyroidectomy procedure requires many manupulations to achieve prompt hemostasis. This study assessed whether the outcomes of thyroidectomy using the Ligasure electrothermal vessel sealer were comparable with the conventional suture-ligation technique. We prospectively evaluated 58 consecutive patients who underwent thyroidectomy. Patients were allocated into two groups according to their preference. There were 30 patients in the Ligasure group and 28 patients in the conventional surgery group. Complications, operating time, and hospital stay were compared between the two groups and suture-ligations performed in the Ligasure group were recorded. The age, sex, and indications were similar in the two groups (p > 0.05). Complication rates and hospital stays did not show any difference according to the techniques used. Operating time was shorter in the hemithyroidectomy and total thyroidectomy patients of the Ligasure group (mean ± SD: 77.38 ± 13.71 vs. 99.80 ± 12.53 minutes, p = 0.005; and 102.50 ± 16.69 vs.128.89 ± 19.74 minutes, p = 0.010). The mean ± SD number of suture-ligations for each patient in the Ligasure group was 1.83 ± 2.12. Thyroid surgery using the Ligasure is safe, and its complication rates are comparable to these found with the conventional surgical technique. Use of the Ligasure during hemithyroidectomy and total tyhroidectomy operations provides a significantly shorter operating time.