Experts see welcome decrease in stent prices.

This paper describes an outbreak of postoperative sternal wound infections. A cardiac surgeon noted a cluster of serious infections leading to wound dehiscence, despite the fact that none of his colleagues had noticed a rise in infection rates. The infections were predominantly with Enterobacter cloacae, and molecular typing and serotyping showed these isolates to be indistinguishable. Observation of the surgeon's practice revealed nothing untoward, and there were no infections among his patients operated on in another hospital. There appeared to be no significant difference between the modes of operation of the different surgeons. The operating theatres were screened to exclude an environmental source, with samples cultured on CHROMagar Orientation, a selective/differential medium designed for urine samples. Further questioning revealed one difference between the practices of the different surgeons; this surgeon used semi-frozen Hartmann's solution to achieve cardioplegia. The freezer used for this was swabbed and yielded E. cloacae, indistinguishable from the clinical isolates. It is hypothesized that this organism contaminated the freezer, and that the contamination was passed on to the ice/slush solution, thus infecting the patients. There have been no more cases since the freezer was replaced, a rigorous cleaning schedule instituted, and steps taken to reduce the possibility of any further contamination.

Cardiovascular Surgical Procedures↗

PubMed2006

Impact of the European Working Time Directive on exposure to operative cardiac surgical training.

OBJECTIVE: To evaluate the impact of the reduced working hours, an anticipated decline in case load and increasing patient risk profile, we performed a cohort study to determine the factors that influenced operative surgical training. METHODS: A historic cohort study design was utilised, and data were acquired from a prospective operative surgical database a year before, and a year after the introduction of the European Working Time Directive (EWTD) compliant rota (1st August 2004). Logistic regression was used to determine the predictors of operative surgical training, and individual variables were ranked by likelihood ratio. RESULTS: In total, 3312 cardiac surgical operations were performed over a 2-year period between 3rd August 2003 and 31st July 2005. The proportion of cases performed by trainees was 39% (626/1587) in the year before and 40% (695/1725) in the year after the introduction of WTD compliant rota. There were no differences in operative risk (logistic EuroSCORE of 8, P=0.853). Independent predictors for surgery performed by a trainee (in descending order of influence) were the consultant in charge (chi11(2) 273.1; P<0.001), procedure performed (chi5(2) 163.5; P<0.001), increasing seniority of trainee (chi2(2) 142.3; P<0.001), revision surgery (chi1(2) 45.9; P<0.001), lower EuroSCORE (chi1(2) 17.6; P<0.001), and better ventricular function (chi2(2) 7.8; P=0.020). The odds ratio of an operation performed by a trainee increased after the introduction of the EWTD compliant rota to 1.19 (95% CI 1.00-1.41; P=0.045). CONCLUSIONS: With a successful institution-specific training module and a commitment to training, exposure to operative surgical training can be sustained despite shortening of working hours.

Cardiovascular Surgical Procedures↗