With technology developed at UC Riverside, scientists can, for the first time, make high resolution images of the human spinal cord during surgery. The advancement could help bring real relief to millions suffering chronic back pain.
The technology, known as fUSI or functional ultrasound imaging, not only enables clinicians to see the spinal cord, but also enables them to map the cord’s response to various treatments in real time. A paper published today in the journal Neuron details how fUSI worked for six people undergoing electrical stimulation for chronic back pain treatment.
“The fUSI scanner is freely mobile across various settings and eliminates the requirement for the extensive infrastructure associated with classical neuroimaging techniques, such as functional magnetic resonance imaging (fMRI),” said Vasileios Christopoulos, assistant professor of bioengineering at UCR who helped develop the technology. “Additionally, it offers ten times the sensitivity for detecting neuroactivation compared to fMRI.”
Until now, it has been difficult to evaluate whether a back pain treatment is working since patients are under general anaesthesia, unable provide verbal feedback on their pain levels during treatment. “With ultrasound, we can monitor blood flow changes in the spinal cord induced by the electrical stimulation. This can be an indication that the treatment is working,” Christopoulos said.
The spinal cord is an “unfriendly area” for traditional imaging techniques due to significant motion artifacts, such as heart pulsation and breathing. “These movements introduce unwanted noise into the signal, making the spinal cord an unfavorable target for traditional neuroimaging techniques,” Christopoulos said.
By contrast, fUSI is less sensitive to motion artifacts, using echoes from red blood cells in the area of interest to generate a clear image. “It’s like submarine sonar, which uses sound to navigate and detect objects underwater,” Christopoulos said. “Based on the strength and speed of the echo, they can learn a lot about the objects nearby.”
Christopoulos partnered with the USC Neurorestoration Center at Keck Hospital to test the technology on six patients with chronic low back pain. These patients were already scheduled for the last-ditch pain surgery, as no other treatments, including drugs, had helped to ease their suffering. For this surgery, clinicians stimulated the spinal cord with electrodes, in the hopes that the voltage would alleviate the patient’s discomfort and improve their quality of life.
“If you bump your hand, instinctively, you rub it. Rubbing increases blood flow, stimulates sensory nerves, and sends a signal to your brain that masks the pain,” Christopoulos said. “We believe spinal cord stimulation may work the same way, but we needed a way to view the activation of the spinal cord induced by the stimulation.”
The Neuron paper details how fUSI can detect blood flow changes at unprecedented levels of less than 1mm/s. For comparison, fMRI is only able to detect changes of 2cm/s.
“We have big arteries and smaller branches, the capillaries. They are extremely thin, penetrating your brain and spinal cord, and bringing oxygen places so they can survive,” Christopoulos said. “With fUSI, we can measure these tiny but critical changes in blood flow.”
Generally, this type of surgery has a 50% success rate, which Christopoulos hopes will be dramatically increased with improved monitoring of the blood flow changes. “We needed to know how fast the blood is flowing, how strong, and how long it takes for blood flow to get back to baseline after spinal stimulation. Now, we will have these answers,” Christopoulos said.
Moving forward, the researchers are also hoping to show that fUSI can help optimise treatments for patients who have lost bladder control due to spinal cord injury or age. “We may be able to modulate the spinal cord neurons to improve bladder control,” Christopoulos said.
“With less risk of damage than older methods, fUSI will enable more effective pain treatments that are optimised for individual patients,” Christopoulos said. “It is a very exciting development.”
A neurosurgeon alleged during his employment tribunal that a “gang culture” exists within the neurosurgery department of an NHS hospital already beset by claims of a toxic culture and investigations into negligence.
As reported by the BBC, Dr Mansoor Foroughi was dismissed from University Hospitals Sussex in 2022 for misconduct. At a separate employment tribunal, Krish Singh, the former clinical director for general surgery, claimed that rota changes reduced the number of “safe” consultants, putting patients at risk.
Four whistleblowers had also told the BBC of a “Mafia-like” culture, where patients had died unnecessarily and others “maimed”. These new allegations came to light as the BBC and The Times fought a nine-month court battle to have the employment tribunal documents unsealed.
Dr Foroughi alleges that one colleague was signed off to do complex spinal procedures despite lacking training, another performed procedures with a “disproportionate” mortality rate, and yet another took on private work while on call to the NHS – a serious breach of conduct.
University Hospital Sussex encompasses several hospitals, which includes Royal Sussex Country Hospital, which has been the source of many complaints, and a history of poor service delivery, which was put into special measures between 2016 and 2019.
At least 105 cases of alleged medical negligence from failings at the hospital’s neurosurgery and general surgery departments are being investigated by police. According to court documents, there was “serious dysfunctionality in the neurosurgery department” with “stark divisions between colleagues”.
An investigation by the Royal College of Surgeons found that “a culture of fear” existed in the hospital’s surgery department, and that senior staff were “dismissive and disrespectful”. Two staff were allegedly assaulted.
In a statement, the trust said: “The trust will vigorously contest these claims at the Employment Tribunals, which we are keen take place at the earliest opportunity so they can be examined properly and fairly.
“Dismissing anyone, or removing someone from a leadership role, is an absolute last resort and we would always seek to avoid this outcome if possible.
“In both of these cases, due process was followed, and we are confident we did the right things, in the right way, for the benefit of our patients, their care and safety.”
Withdrawing aspirin one month after percutaneous coronary intervention (PCI) in high-risk heart patients and keeping them on ticagrelor alone safely improves outcomes and reduces major bleeding by more than half when compared to patients taking aspirin and ticagrelor combined (also known as dual antiplatelet therapy or DAPT), which is the current standard of care.
These are the results from the ULTIMATE-DAPT study announced during a late-breaking trial presentation at the American College of Cardiology Scientific Sessions on Sunday, April 7, and published in The Lancet.
This is the first and only trial to test high-risk patients with recent or threatened heart attack (acute coronary artery syndromes, or ACS) taking ticagrelor with a placebo starting one month after PCI, and compare them with ACS patients taking ticagrelor with aspirin over the same period. The significant findings could change the current guidelines for standard of care worldwide.
“Our study has demonstrated that withdrawing aspirin in patients with recent ACS one month after PCI is beneficial by reducing major and minor bleeding through one year by more than 50 percent. Moreover, there was no increase in adverse ischaemic events, meaning continuing aspirin was causing harm without providing any benefit,” says Gregg W. Stone, MD, the study co-chair of ULTIMATE-DAPT, who presented the trial results.
“It is my belief that it’s time to change the guidelines and standard clinical practice such that we no longer treat most ACS patients with dual antiplatelet therapy beyond one month after a successful PCI procedure. Treating these high-risk patients with a single potent platelet inhibitor such as ticagrelor will improve prognosis,” adds Dr Stone.
The study analysed 3400 patients with ACS at 58 centres in four countries between August 2019 and October 2022. All of the patients had undergone PCI, a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow. The patients were stable one month after PCI and were on ticagrelor and aspirin. Researchers randomised the patients after one month, withdrawing aspirin in 1700 patients and putting them on ticagrelor and a placebo, while leaving the other 1700 patients on ticagrelor and aspirin. All patients were evaluated between 1 and 12 months after the procedure.
During the study period, 35 patients in the ticagrelor-placebo group had a major or minor bleeding event, compared to 78 patients in the ticagrelor-aspirin group, meaning that the incidence of overall bleeding incidents was reduced by 55 percent by withdrawing aspirin. The study also analysed major adverse cardiac and cerebrovascular events including death, heart attack, stroke, bypass graft surgery, or repeat PCI. These events occurred in 61 patients in the ticagrelor-placebo group compared to 63 patients in the ticagrelor-aspirin group, and were not statistically significant – further demonstrating that removing aspirin did no harm and improved outcomes.
“It was previously believed that discontinuing dual antiplatelet therapy within one year after PCI in patients with ACS would increase the risk of heart attack and other ischaemic complications, but the present study shows that is not the case, with contemporary drug-eluting stents now used in all PCI procedures. Discontinuing aspirin in patients with a recent or threatened heart attack who are stable one month after PCI is safe and, by decreasing serious bleeding, improves outcomes,” Dr Stone adds. “This study extends the results of prior work that showed similar results but without the quality of using a placebo, which eliminates bias from the study.”
By HualinXMN – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=133759262
New research from Cedars-Sinai found that glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with an increased risk of aspiration pneumonia following endoscopy. The large, population-based study is published in the leading peer-reviewed journal Gastroenterology.
One way the new obesity medications work is by slowing digestion, so people feel full longer, causing them to eat less.
This also means that food sits in the stomach longer. As a result, the stomach may not empty completely during the usual duration of fasting that is recommended ahead of a surgical procedure to decrease risk of aspiration, explained the study’s corresponding author, Ali Rezaie, MD, medical director of the GI Motility Program and director of bioinformatics at the MAST Program at Cedars-Sinai.
“Aspiration during or after endoscopy can be devastating,” Rezaie said.
“If significant, it can lead to respiratory failure, ICU admission and even death. Even mild cases may require close monitoring, respiratory support and medications including antibiotics. It is important we take all possible precautions to prevent aspiration from occurring.”
The study analysed data from nearly 1 million de-identified U.S. patients who underwent upper or lower endoscopy procedures between January 2018 and December 2020.
Patients who were prescribed GLP-1RA medications had a 33% higher chance of experiencing aspiration pneumonia than those who did not take these medications before the procedure.
This comparison also considered other variables that could influence the outcome to ensure a fair comparison between the two groups.
“When we apply this risk to the more than 20 million endoscopies that are performed in the U.S. each year, there may actually be a large number of cases where aspiration could be avoided if the patient safely stops their GLP-1RA medication in advance,” Rezaie said.
“The results of this study could change clinical practice,” said Yee Hui Yeo, MD, first author of the study and a clinical fellow in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai. “Patients taking these medications who are scheduled to undergo a procedure should communicate with their healthcare team well in advance to avoid unnecessary and unwanted complications.”
The two most common obesity surgeries, gastric bypass and gastric sleeve, have few short-term complications and show no significant differences, according to study findings published in the journal JAMA Network Open. These are the first results of a multicentre randomised controlled trial comparing obesity surgeries conducted by the University of Gothenburg.
Patients undergoing obesity surgery will normally have a BMI of at least 40, or 35 if they also have other serious medical conditions related to obesity.
The most common procedures are gastric bypass, where a large part of the stomach and part of the small intestine are bypassed, and gastric sleeve, where a large part of the stomach is surgically removed.
The aim of the current study was to compare the short-term risks of the different procedures.
The study is the largest of its kind. 1735 adult patients planned for surgery in Norway and Sweden between 2015 and 2022 agreed to participate, and they were randomly assigned to either gastric bypass or gastric sleeve.
Relatively few complications
Surgical time was longer for gastric bypass, averaging 68 minutes compared to 47 minutes for gastric sleeve, but hospitalisation after surgery was one day regardless of method.
The follow-ups also gave equivalent results for the two methods.
At 30 days after surgery, both groups had relatively few complications such as haemorrhage, leakage, blood clots and infections.
No deaths occurred during the follow-up period of a total of 90 days.
“For both surgical procedures, the risk of complications is very low, especially from an international perspective, and there is no statistically significant or clinically relevant difference between the groups,” says Suzanne Hedberg, first author of the study.
Many stakeholders and many opinions
“Many people have had surgery, or are on waiting lists for surgery, and there are lots of discussions and opinions about the different methods. What the study shows is that patients and doctors can now choose their surgical method without considering short-term surgical risks,” she says.
Suzanne Hedberg defended her thesis in surgery at Sahlgrenska Academy, University of Gothenburg in April 2023, and is a consultant at Sahlgrenska University Hospital.
The study, included in her thesis, is the first publication with results from BEST (Bypass Equipoise Sleeve Trial), a Scandinavian registry-based randomised controlled multicentre study comparing the two methods of obesity surgery.
The main outcome of the trial which analyses the risk of complications and weight progression over 5 years, is expected to be completed in 2028.
“For the ongoing studies, we are off to a good start with equivalent groups, laying a good foundation for further comparisons of more long-term results,” concludes Suzanne Hedberg.
Including patients as partners for making decisions about their medical treatments is an important aspect of patient-centred care. A new study from England examined choices that patients with breast cancer make when considering where to have surgery for their condition and assessed how policies that offer such choices might affect inequalities in the health care system. The findings are published in CANCER.
For the study, investigators analysed data from the National Health Service (NHS), the publicly funded health care system in the United Kingdom that offers patients with cancer the opportunity to select any hospital providing cancer treatment, and identified all women diagnosed with breast cancer from 2016 to 2018 who had breast-conserving surgery or a mastectomy.
Records showed that 22 622 of 69,153 patients undergoing breast-conserving surgery (32.7%) and 7179 of 23 536 patients undergoing mastectomy (30.5%) bypassed their nearest hospital to receive surgery farther away from home. Women who were younger, without additional medical conditions, of white ethnic background, or lived in rural areas were more likely to travel to more distant hospitals.
Patients were more likely to be treated at hospitals classified as specialist breast reconstruction centres even if they personally were not undergoing breast reconstruction after surgery. Patients who had a mastectomy and immediate breast reconstruction were more likely to travel to hospitals that had surgeons with a strong media reputation for breast cancer surgery, and patients were less likely to travel to hospitals with shorter surgical waiting times. Patients did not seem to make choices based on hospitals’ research activity, quality rating, breast re-operation rates (to remove additional cancer cells that were missed), or status as a multidisciplinary cancer centre (where patients can receive all their care at one location).
The investigators noted that this separation – elderly patients, those with comorbidities, and those from ethnic minority backgrounds receiving care at their local hospital, while others travel to other hospitals and specialist centres – could further drive inequalities in access to quality care.
“As marginalized groups already face barriers to high-quality care, it is important for policy makers to consider measures that mitigate against the risks of increasing inequalities in access and outcomes, by for example providing free transport, accommodation, or even protection against loss of income,” said co-author Lu Han, PhD, of the London School of Hygiene & Tropical Medicine. “Moreover, patients prefer to access information on the quality of breast cancer care of the hospitals in their region at the start of the management pathway when a diagnosis is sought. Such information should be easy to understand and presented in a format that can support the trade-offs that patients have to make.”
Young people who have had surgery for obesity do not improve their mental health despite significant and permanent weight loss. At the same time, bariatric surgery also increases the risk of early alcohol problems. This is according to the largest long-term study of young people who have undergone bariatric surgery, the results of which were published in Lancet Child and Adolescent Health.
The researchers studied mental health problems – before and after surgery – among all young people in Sweden who underwent bariatric surgery between 2007 and 2017. The study was conducted using register data, which enabled the scope of the study and facilitated comparisons with other groups in society.
The study recruited 1554 adolescents (< 21 years) with severe obesity underwent bariatric surgery between 2007 and 2017, 1169 (75%) of whom were female. At time of surgery, the mean age was 19·0 years [SD 1·0], and the mean BMI was 43·7 kg/m2 (SD 5·5). They were matched with 15 540 adolescents from the general population.
It was found that young people who underwent surgery were more likely to have received treatment and medication for mental health problems already five years before the surgery.
“Although mental illness generally increases between the ages of 15 and 21, for this group the need for treatment increased faster than for young people in general”, says Kajsa Järvholm, Associate Professor of Psychology at Lund University.
Unfortunately, this pattern continued even after obesity surgery; the young people who had the surgery continued to have a greater need for mental health treatment than their peers.
“Obesity surgery has very positive effects on weight, blood sugar and blood pressure control, but when it comes to mental health, it does not get better or worse after bariatric surgery”, says Martin Neovius, Professor of Clinical Epidemiology at Karolinska Institutet.
Additional findings from the new study include an increase in dependency diagnoses, particularly on alcohol, in the surgical group, both in comparison to pre-surgery and to young people in general.
The study is the largest long-term study in the world of young people who have had obesity surgery.
Already long surgical waiting lists in the Northern Cape appear to have ballooned in recent months. In May, the province’s MEC for Health Maruping Lekwene told the province’s legislature that surgical waiting lists in the province stood at just under 4000. According to more recent figures from the Northern Cape Department of Health’s 2023/24 First Quarterly report, the surgical backlog stands at 6373 – an increase of more than 50% on the figure given in May.
Lulu Mxekezo, Northern Cape Department of Health Spokesperson, confirmed to Spotlight last week that the surgical backlogs had indeed increased from around 4000 to around 6000. She said that the numbers fluctuate as the need continues to increase on a daily basis.
“The shortage of specialised theatre staff makes it impossible for us to utilise all theatres daily to perform the procedures,” said Mxekezo, adding that the department will not compromise the safety and lives of patients and operate in theatres with no specialised theatre staff.
The increase in the backlog came despite the outsourcing of some surgical services in the province. Lekwene told the legislature that the Northern Cape Department of Health pays Gauteng-based Medicomed (captured as Medicore-Mets in the legislature minutes) R400 000 per month to assist with orthopaedic surgeries at Robert Mangaliso Sobukwe (RMS) Hospital in Kimberly on a month-to-month basis. He said the company supplies the department with specialised theatre nurses which is a scarce skill in the province. In May, Lekwene told legislators that the company had assisted with 57 surgeries over a two-week period.
Lack of theatre staff
The quarterly report stated that the backlog is fuelled by the lack of theatre staff at RMS hospital, and that the private sector was called in to fill this gap.
When asked by Izak Fritz, Democratic Alliance member of the Provincial Legislature, why the department does not appoint specialist nurses instead of outsourcing these services, Lekwene answered that there are unfortunately not enough theatre specialist nurses in the province.
“For us to take this route, it means that we need to have internal capacity. For instance we will have a neurosurgeon but we will not have an anaesthetist. We have nurses, but we do not have theatre specialist nurses,” he said.
He said they do not enjoy outsourcing, but that because of the urgency and the growing backlog the department has to act swiftly. “However as soon as the backlog has been reduced, we will then try to use our internal staff,” he said.
Lekwene also told the legislature that the backlog was mostly caused by the Covid-19 pandemic. “Remember that for two years during Covid-19, hospitals were closed,” he said.
Left stranded
Some workers at RMS said the long waiting list has left many patients frustrated and stranded. One doctor described the situation to Spotlight as “dire”. “The hospital has four fully equipped theatres but patients do not get help,” he said. He asked not to be named for fear of losing his job.
“Yes, we do have a shortage of nurses, but it is not as bad as they say. We are available as doctors, but without the help from nurses we are unable to perform surgeries at all,” he said.
The doctor said that currently the list of patients that need to receive emergency surgery is longer than 30. He said that for ordinary surgeries such as hip replacements there are patients who have been in hospital for more than 18 months, while some have been waiting for cataract surgery for five years.
A strain on staff and patients
Dennis Segano, provincial chairperson of Health and Other Services Personnel Trade Union in South Africa (HOSPERSA) said the surgery backlog is putting a strain on both nurses and patients.
He said the main problems that they see at RMS is the shortage of specialised theatre nurses and a lack of equipment. “When you enter the theatres there are enough doctors but not enough nurses,” he said. “We have a problem with our theatre nurses who are often outsourced by the service provider to work during their surgery marathons at the RMS hospital but have to wait three months or sometimes even six months before they can get paid.”
Spotlight asked Mxekezo about the late payment allegations but had not received a response by the time of publication.
“We don’t know why the government is not appointing the nurses instead of paying a service provider,” Segano said. “The system is burdened, the nurses in orthopaedic wards are burdened and we feel sad for the patients who have to spend months in hospital. “As a patient when you have a fracture, you must be able to go to theatre immediately, but in this province, you have to wait months before you receive help.”
“Stakeholders are also assisting us in performing theatre marathons to deal with the backlog,” Mxekezo said.
For example, in October last year, disaster relief organisation Gift of the Givers sent a team of theatre nurses and anaesthetists to assist with the backlog at RMS. According to Ali Sablay, the organisations project manager, they performed 72 operations on 72 patients during the catch-up drive.
Long-term solution
When asked what the department’s long-term plans are to reduce the pressure, Mxekezo explained that the operationalisation of theatres in district hospitals with specialised theatre staff will assist in minimising the backlog at RMS as many patients are transferred from districts.
Segano agreed that a long-term solution is to equip district hospitals with decent theatres and specialised theatre nurses.
“Minor fractures must be dealt with at district hospitals. RMS Hospital must only perform serious surgeries,” he said. “If the department can prioritise Harry Surtie Hospital and De Aar Hospital with theatre staff and equipment, RMS Hospital will operate much better and the patients will be helped. It is incorrect to send all patients of the Northern Cape to one hospital in Kimberly. They will not succeed.”
“Permanent employment of theatre staff will also assist in stabilising the surgical backlogs,” Mxekezo said.
Sceptical opposition
Fritz told Spotlight the DA is very concerned about the growing backlog in the Northern Cape and that they have repeatedly highlighted surgery backlogs at the provinces only tertiary facility (RMS).
“When one looks at nursing appointments at the RMS hospital, we see a trend whereby more nurses’ contracts are terminated each year than the amount of nurses who actually get appointed,” he said. “In effect, the hospital only operationalises four of its nine theatres.”
“Despite agreements with private agencies for surgery marathons to help tackle the backlogs, this only has a limited impact because of the inability to operationalise more theatres and to ensure there is an availability of more beds for recovery,” he said.
Fritz said the reality is that the people who require elective surgery often have to wait years to be attended to while their condition progresses. “Only when their case becomes an emergency can they be bumped up the list, and by that time their disease has become worse and their hopes of a full recovery is minimised,” he said.
Wynand Boshoff, the Freedom Front Plus’s (FF+) Northern Cape Provincial Leader, said in an interview with Spotlight last week that the problem with the department is that it is an entity that is riddled with mismanagement and a culture which aims for anything but service delivery.
He said the FF+ is not only approached by patients, but also by doctors on a regular basis who want to leave the health department because of management that he said has completely abandoned services.
“It is clear that more is needed than the appointment of a new minister or a new Head of Department, as the legacy of mismanagement overwhelms individual role players. A comprehensive investigation and steadfast disciplinary action is needed,” he said. “Repeat offenders should not be tolerated in the department, not even in the most humble of positions.”
As Spotlight previously reported, the Northern Cape Department of Health has had several acting heads in the last three years and several senior officials have and are facing charges in court. The current Head of Department is Dr Alastair Kantani, who has been acting in the position since 8 September following the arrests of seven officials, including former head Dr Dion Theys who now occupies the post of Medical Director in the department. In a statement issued by the department on 13 September Lekwene said this action is informed by the constitutional responsibility to ensure relative stability in the delivery of healthcare services in the province.
Patients taking Glucagon-like peptide-1 (GLP-1) receptor agonists should stop taking them before they have surgery, due to the risk of aspirating while under general anaesthesia. This is the latest advice from the American Society of Anesthesiologists (ASA).
Initially approved by the Food and Drug Administration (FDA) for type 2 diabetes mellitus and cardiovascular risk reduction, GLP-1 agonists have shot up in popularity due to their effectiveness in weight loss. Despite having recent FDA approval, they have been used off-label for this purpose for quite some time.
When it comes to surgery, a number of organisations have recommended to hold these drugs either the day before or day of the procedure. For patients on weekly dosing, it is recommended to hold the dose for a week, the ASA notes.
GLP-1 agonists are associated with adverse gastrointestinal effects such as nausea, vomiting and delayed gastric emptying. The effects on gastric emptying are reported to be reduced with long-term use, most likely through rapid tachyphylaxis at the level of vagal nerve activation. Based on recent anecdotal reports, there are concerns that delayed gastric emptying from GLP-1 agonists can increase the risk of regurgitation and pulmonary aspiration of gastric contents during general anaesthesia and deep sedation. Patient taking GLP-1 agonists are more likely to have increased residual gastric contents as predicted by adverse gastrointestinal symptoms (nausea, vomiting, dyspepsia, abdominal distension).
The use of GLP-1 agonists in paediatrics has primarily been reported for the management of type 2 diabetes mellitus and obesity. The published literature on GLP-1 agonists in paediatrics is predominantly from paediatric patients 10 to 18 years old and concerns are similar to those reported in adults. During the conduct of general anaesthesia/deep sedation, children on GLP-1 agonists have similar gastrointestinal adverse events at a rate similar to adults.
In a review of the literature, the ASA Task Force on Preoperative Fasting found that, beyond a few case reports, there was little evidence for guidance on preoperative management of GLP-1 agonists. Nevertheless, they made recommendations for elective procedures. In the case of urgent or emergent procedures, they suggested treating the patient as ‘full stomach’.
If the patient’s GLP-1 agonists prescribed for diabetes management are held for longer than the dosing schedule, the guidelines urge surgeons to consider consulting an endocrinologist for bridging the antidiabetic therapy in order to avoid hyperglycaemia.
They further recommend that if gastrointestinal symptoms, such as severe nausea/vomiting/retching, abdominal bloating, or abdominal pain, are present, surgeons should consider delaying elective procedures. If the patient has no gastrointestinal symptoms and the GLP-1 agonists have been held as advised, the surgical team can carry on as normal.
In a new research perspective published in Oncoscience, researchers from Germany discuss the diagnosis and management of postoperative wound infections in the head and neck area. Key topics include patient risk factors, the importance of sterilisation, and the most common complications.
In everyday clinical practice at a department for oral and maxillofacial surgery, a large number of surgical procedures in the head and neck region take place under both outpatient and inpatient conditions. The basis of every surgical intervention is the patient’s consent to the respective procedure. Particular attention is drawn to the general and operation-specific risks.
Particularly in the case of soft tissue procedures in the facial region, bleeding, secondary bleeding, scarring and infection of the surgical area are among the most common complications/risks, depending on the respective procedure. In their new perspective, researchers Filip Barbarewicz, Kai-Olaf Henkel and Florian Dudde from Army Hospital Hamburg in Germany discuss the diagnosis and management of postoperative infections in the head and neck region.
“In order to minimise the wound infections/surgical site infections, aseptic operating conditions with maximum sterility are required.”
Furthermore, depending on the extent of the surgical procedure and the patient‘s previous illnesses, peri- and/or postoperative antibiotics should be considered in order to avoid postoperative surgical site infection. Abscesses, cellulitis, phlegmone and (depending on the location of the procedure) empyema are among the most common postoperative infections in the respective surgical area. The main pathogens of these infections are staphylococci, although mixed (germ) patterns are also possible.
“Risk factors for the development of a postoperative surgical site infection include, in particular, increased age, smoking, multiple comorbidities and/or systemic diseases (eg, diabetes mellitus type II) as well as congenital and/ or acquired immune deficiency.”
