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Proposed definitions for the audit of postoperative infection: a discussion paper. Surgical Infection Study Group.

Infection is an important arbiter of success or failure of surgical practice and the incidence of infection is incorporated into all surgical audit systems. If audit is to be of value the outcome end points of clinical practice must be defined. We have attempted to derive clinical definitions suitable for bedside diagnosis of infection and believe that these should bs supported by, but not be dependent upon, the results of laboratory or imaging techniques. The proposed definitions are intended to form the basis for clinical audit and to allow meaningful comparisons to be made on clear clinical criteria.

Bacterial Infections↗

[Pleural empyema as a complication of gastrointestinal interventions].

The diagnosis of empyema following gastrointestinal operations is usually established at an early stage (Stage I/II in 23 of our own 29 patients). The decisive factor in therapy is the careful and precise insertion of a drainage tube under radiologic control (ultrasound, CT) followed by efficient suction drainage. Nevertheless mortality in this special group of postoperative septic complications was 56%, since extrathoracic sepsis could not always be eliminated promptly enough when diffuse peritonitis was the source of sepsis.

Empyema, Pleural↗

[Extended, combined and associated resection of the liver].

The authors describe their observations of 227 patients after operations for focal lesions of the liver. Radical operations were performed on 93 patients, 61 being subjected to extended, combined and associated resections of the liver. Most operations were made as atypical resections of the liver. In order to reduce the operation blood loss the authors recommend to fulfil temporary exclusion of the liver from blood circulation by compression of the hepato-duodenal ligament. The temporary external drainage of bile ducts is recommended as a preventive measure against post-operative bile peritonitis. Postoperative lethality after extended, combined and associated resections of the liver was 9.8%.

Cholecystectomy↗