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Biomedical subjects

P Brough

Publications and source records attributed to P Brough.

4 recordsLinked to original sources
PubMed1992

Community surveillance of complications after hernia surgery.

OBJECTIVE: To assess the effect of a programme of postoperative community surveillance on the rate of detection of wound complications after operation for inguinal hernia. DESIGN: Prospective audit of wound complications including complications recorded in case notes and those discovered by community surveillance. SETTING: Academic surgical unit of three consultant surgeons. PATIENTS: 510 patients undergoing elective inguinal hernia repair between June 1985 and August 1989. RESULTS: The wound infection rate recorded in the hospital notes was 3% compared with 9% when additional information was obtained from community surveillance. Wound complications were detected in 143 (28%) patients by community surveillance compared with a complication rate of 7% in the case records for the same patients. CONCLUSIONS: Wound complications are common after clean surgery in patients discharged home early. Complication rates are a reflection not only of the standards of surgical practice but also the rigour with which they are sought. Before national comparative audit data are published the method of collection must be standardised. For short stay surgery this should include meaningful community surveillance.

Anti-Bacterial Agents↗
PubMed1992

Antibiotic prophylaxis in clean surgical cases and the role of community surveillance.

In an ongoing prospective study of clean surgical procedures, patients have been examined by specialist research nurses on a minimum of three occasions during the postoperative period to determine the incidence of wound complications. Whereas a previous retrospective audit suggested a wound infection rate of 2%, this community surveillance programme revealed the true rate as at least fourfold greater (p less than 0.001). Of these complications, more than 70% were detected only by the surveillance programme. Immediate benefit was obtained by a reduction in all complications. Despite these improvements, a core of postoperative sepsis remained, particularly in high-risk cases. Thus, a prospective, controlled, prophylactic antibiotic trial has been undertaken, in an attempt to reduce the infection rate still further. An antibiotic regimen of teicoplanin, 400 mg i.v., given as a single dose, was chosen because of the excellent activity of this agent against staphylococci and streptococci, and also because of the long half-life which renders it suitable for single-dose administration.

Anti-Bacterial Agents↗