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The Association of Intra-Abdominal Infection and Abdominal Wound Dehiscence
PERIOPERATIVE CARE
and 4 percent and 1percent for PEG, respectively (P = not significant). CONCLUSION: Both oral solutions proved to be equally effectiveand safe. However, patient tolerance of the small volume of NaP demonstrated a clear advantage over the traditional PEG solution.
Editorial Comment: Mechanical bowel preparation is performed often before urological proCedureS that Use open bowel segments. We have used standard polyethylene glycol but this requires the patient to drink a large amount of fluid in a brief time. These authors compared in a randomized fashion 4 1. polyethylene glycol solution or 90 cc sodium phosphate. Patients tolerated the sodium phosphate better and there was no difference in a blinded surgeon msessment of bowel cleansing. Sodium phosphate can cause increased serum phosphate levels as well as hypocalcemia, and it should not be used in patients with renal failure or congestiveheart failure. Hypokalemiacan result, and so caution is required in patients on diuretics or digoxin. However, there seems to be some real advantages with regard to patient comfort and tolerability of the solution. Joseph k Smith, Jr., M.D. The Association of Intra-Abdominal Infection and Abdominal Wound Dehiscence
D. J. GRAHAM, J. T.STEVENSON AND C . R. MCHENRY, Department of Surgery, Case Western Reserve University, Cleveland Veterans w a i r s Medical Center and MetroHealth Medical Center, Cleveland, Ohio h e r . Surg., 64:660-665, 1998 Concurrent infection is a risk factor for abdominal wound dehiscence. We reviewed our experience with fascia1 dehiscence to determine the incidence and to identify prognostic factors for associated intraabdominal infection. Over a 7-year period, 107 patients with abdominal wound dehiscence were identified. Seventeen were managed nonoperatively, and 90 underwent exploratory laparotomy, 43 of whom had no intra-abdominal pathology and 47 of whom had intra-abdominal infections. Demographic factors, comorbid diseases, and potential indicators of systemic infection did not distinguish patients with intra-abdominal infection from those without. Patients with an intra-abdominal infection were more likely to have undergone an emergency operation (74%vs 48%; P <0.02), an operation on the colon (55%vs 25%; P <0.005), or an operation with a higher wound classification (P <0.02). Mortality was higher in patients with intraabdominal infection than in those without (44% vs 20%; P <0.02).Wound dehiscence after emergent operations, and operations with a higher wound classification, especially those involving the colon, should raise concern for intra-abdominal infection. Thorough abdominal exploration should be performed at the time of dehiscence repair. Before nonoperative management is chosen, intra-abdominal infection should be excluded.
Editorial Comment: Of multiple factors often associated with wound dehiscence infection is observed frequently. A wound infection superficial to the fascia is easily recognizable. These authors also found a relatively high incidence of intra-abdominalinfections in patients with wound dehiscence. They recommend thorough intra-abdominal exploration at the time of repair. Lf closure ofthe wound does not have to be performed immediately, abdominal computerized tomography may also be a good idea when intra-abdominal infection is suspected. Joseph A. Smith, Jr., M.D. Patient-ControlledAnalgesia: An Assessment by 200 Patients G. M. CWBLEY,G.M. HALL AND P. SALMON, Department of Anaesthesia, St. George’s Hospital Medical School, London and Department of Clinical Psychology, University of Liverpool, Liverpool, United Kingdom Anaesthesia, 63: 216-221, 1998 Permission to Publish Abstract Not Granted Editorial Comment: In randomized trials patient controlled analgesia has been associated with an increase in patient satisfaction compared with intramuscular or epidural narcotic anministration without increasing the total amount of analgesic used. The ability of the patient to control the amount and frequency of narcotic administration,and to titrate these against the amount of pain and side effects are cited most often as the advantages of patient controlled analgesia questionnaire study implies that the issue of patient control is mainly justified by the doctor or n m . The patients who participated in the survey tended not to push the button unless prompted and expressed concerns about side effects, which often led to under medication. This i m e Beems to be primarily about patient education. It is unfair to expect patients to BBBume control for =me aspects of care without providing enough education and information 80 that they can do 80 in an informed manner. Joseph A. Smith, Jr., M.D.
371
and 4 percent and 1percent for PEG, respectively (P = not significant). CONCLUSION: Both oral solutions proved to be equally effectiveand safe. However, patient tolerance of the small volume of NaP demonstrated a clear advantage over the traditional PEG solution.
Editorial Comment: Mechanical bowel preparation is performed often before urological proCedureS that Use open bowel segments. We have used standard polyethylene glycol but this requires the patient to drink a large amount of fluid in a brief time. These authors compared in a randomized fashion 4 1. polyethylene glycol solution or 90 cc sodium phosphate. Patients tolerated the sodium phosphate better and there was no difference in a blinded surgeon msessment of bowel cleansing. Sodium phosphate can cause increased serum phosphate levels as well as hypocalcemia, and it should not be used in patients with renal failure or congestiveheart failure. Hypokalemiacan result, and so caution is required in patients on diuretics or digoxin. However, there seems to be some real advantages with regard to patient comfort and tolerability of the solution. Joseph k Smith, Jr., M.D. The Association of Intra-Abdominal Infection and Abdominal Wound Dehiscence
D. J. GRAHAM, J. T.STEVENSON AND C . R. MCHENRY, Department of Surgery, Case Western Reserve University, Cleveland Veterans w a i r s Medical Center and MetroHealth Medical Center, Cleveland, Ohio h e r . Surg., 64:660-665, 1998 Concurrent infection is a risk factor for abdominal wound dehiscence. We reviewed our experience with fascia1 dehiscence to determine the incidence and to identify prognostic factors for associated intraabdominal infection. Over a 7-year period, 107 patients with abdominal wound dehiscence were identified. Seventeen were managed nonoperatively, and 90 underwent exploratory laparotomy, 43 of whom had no intra-abdominal pathology and 47 of whom had intra-abdominal infections. Demographic factors, comorbid diseases, and potential indicators of systemic infection did not distinguish patients with intra-abdominal infection from those without. Patients with an intra-abdominal infection were more likely to have undergone an emergency operation (74%vs 48%; P <0.02), an operation on the colon (55%vs 25%; P <0.005), or an operation with a higher wound classification (P <0.02). Mortality was higher in patients with intraabdominal infection than in those without (44% vs 20%; P <0.02).Wound dehiscence after emergent operations, and operations with a higher wound classification, especially those involving the colon, should raise concern for intra-abdominal infection. Thorough abdominal exploration should be performed at the time of dehiscence repair. Before nonoperative management is chosen, intra-abdominal infection should be excluded.
Editorial Comment: Of multiple factors often associated with wound dehiscence infection is observed frequently. A wound infection superficial to the fascia is easily recognizable. These authors also found a relatively high incidence of intra-abdominalinfections in patients with wound dehiscence. They recommend thorough intra-abdominal exploration at the time of repair. Lf closure ofthe wound does not have to be performed immediately, abdominal computerized tomography may also be a good idea when intra-abdominal infection is suspected. Joseph A. Smith, Jr., M.D. Patient-ControlledAnalgesia: An Assessment by 200 Patients G. M. CWBLEY,G.M. HALL AND P. SALMON, Department of Anaesthesia, St. George’s Hospital Medical School, London and Department of Clinical Psychology, University of Liverpool, Liverpool, United Kingdom Anaesthesia, 63: 216-221, 1998 Permission to Publish Abstract Not Granted Editorial Comment: In randomized trials patient controlled analgesia has been associated with an increase in patient satisfaction compared with intramuscular or epidural narcotic anministration without increasing the total amount of analgesic used. The ability of the patient to control the amount and frequency of narcotic administration,and to titrate these against the amount of pain and side effects are cited most often as the advantages of patient controlled analgesia questionnaire study implies that the issue of patient control is mainly justified by the doctor or n m . The patients who participated in the survey tended not to push the button unless prompted and expressed concerns about side effects, which often led to under medication. This i m e Beems to be primarily about patient education. It is unfair to expect patients to BBBume control for =me aspects of care without providing enough education and information 80 that they can do 80 in an informed manner. Joseph A. Smith, Jr., M.D.
371