Journal of Japan Society for Surgical Infection
Online ISSN : 2434-0103
Print ISSN : 1349-5755
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Showing 1-9 articles out of 9 articles from the selected issue
  • Masanao Nakai, Hiroyuki Yamamoto, Kazuo Tanemoto, Hiroaki Miyata, Nobo ...
    2020 Volume 17 Issue 2 Pages 42-54
    Published: April 30, 2020
    Released: May 25, 2020
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    【Objects】Surgical site infection (SSI) in cardiovascular surgery is more likely to be severe and impact clinical outcomes. This study used the registered data of the Japan Cardiovascular Surgery Database (JCVSD) to examine the current status of SSI and its clinical impact.【Methods】 JCVSD data included 253,159 cases of thoracic cardiovascular surgery performed under median sternotomy in 2013〜2017. According to the Japanese Healthcare Associated Infections Surveillance(JHAIS)classification, patients were classified into three groups, CBGB is CABG with SVG (n=72,513), CBGC is CABG without SVG (n=28,579), and CARD is operations other than CABG (n=152,067). The incidence of deep sternum infection, hospital death and long-term hospitalization(more than 90 days)were examined.【Results】The incidence of deep sternum infection is 1.9% in CBGB, 1.5% in CBGC, and 1.5% in CARD, significantly higher in CBGB (P<0.001). Hospital deaths in deep sternum infection cases were 22.9%, significantly higher than non-infection cases (5%) (P<0.001). Long–term hospitalization in deep sternum infection cases was 20.8%, higher than non-infection cases (1.6%). 【Conclusion】The incidence of deep sternum infection is low in JCVSD data. But hospital death and long-term hospitalization is still high.

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  • Masanao Nakai, Hiroyuki Yamamoto, Kazuo Tanemoto, Hiroaki Miyata, Nobo ...
    2020 Volume 17 Issue 2 Pages 54-59
    Published: April 30, 2020
    Released: June 11, 2020
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    【Objects】Surgical site infection (SSI) in cardiovascular surgery is more likely to be severe and impact clinical outcomes. This study used the registered data of the Japan Cardiovascular Surgery Database (JCVSD) to examine the current status of SSI and its clinical impact.【Methods】 JCVSD data included 253,159 cases of thoracic cardiovascular surgery performed under median sternotomy in 2013〜2017. According to the Japanese Healthcare Associated Infections Surveillance(JHAIS)classification, patients were classified into three groups, CBGB is CABG with SVG (n=72,513), CBGC is CABG without SVG (n=28,579), and CARD is operations other than CABG (n=152,067). The incidence of deep sternum infection, hospital death and long-term hospitalization(more than 90 days)were examined.【Results】The incidence of deep sternum infection is 1.9% in CBGB, 1.5% in CBGC, and 1.5% in CARD, significantly higher in CBGB (P<0.001). Hospital deaths in deep sternum infection cases were 22.9%, significantly higher than non-infection cases (5%) (P<0.001). Long–term hospitalization in deep sternum infection cases was 20.8%, higher than non-infection cases (1.6%). 【Conclusion】The incidence of deep sternum infection is low in JCVSD data. But hospital death and long-term hospitalization is still high.

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  • Sanshiro Kawata, Yoshihiro Hiramatsu, Ryoma Haneda, Wataru Soneda, Kaz ...
    2020 Volume 17 Issue 2 Pages 61-66
    Published: April 30, 2020
    Released: May 25, 2020
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    In April 2017, we launched the multidisciplinary Hamamatsu Perioperative Care Team (HOPE) for all surgical patients. We developed a reinforced intervention strategy, particularly for esophagectomy. We investigated risk factors for surgical site infection (SSI) in esophagectomy and report the outcomes of the HOPE. In all, 122 patients underwent esophagectomy and gastric conduit reconstruction for esophageal or esophagogastric junction cancer between January 2012 and December 2017 in the Department of Surgery of Hamamatsu University School of Medicine. The patients were divided into the pre–HOPE group, which included 96 patients who underwent esophagectomy before the introduction of the HOPE, and the HOPE group, which included 26 patients who underwent esophagectomy after the introduction of the HOPE. Complications were graded according to the Clavien–Dindo Classification. Of the 122 patients analyzed, 25 were diagnosed with incisional SSI (>gradeⅡ) and 24 were diagnosed with organ/space SSI (>gradeⅡ). A univariate analysis showed that a preoperative Onodera’s prognostic nutritional index <45 and a Controlling Nutritional Status >2 were risk factors for incisional SSI, and low total protein and cholinesterase levels were risk factors for organ/space SSI. The incidence rates of organ/space SSI were lower in the HOPE group than in the pre–HOPE group (8% vs. 22%, P=0.066). Preoperative poor nutritional status was a risk factor for SSIs. Therefore, multidisciplinary team care was effective in preventing SSIs.

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  • Yoshihiro Nabeya, Isamu Hoshino, Kiyohiko Shuto
    2020 Volume 17 Issue 2 Pages 67-74
    Published: April 30, 2020
    Released: May 25, 2020
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    Anastomotic failure (AF) after esophagectomy for cancer followed by reconstruction is a postoperative infectious complication that worsens the short– and long–term prognosis, and therefore, prevention is of primary importance. However, it is also important to take measures to reduce infection and inflammation immediately after AF occurs and to prevent the complication from becoming severe. In this study, we examined the appropriate measures and nutritional management based on the analyses of clinical course of 10 AF cases out of 200 patients who underwent esophagectomy in our department. Although the incidence of AF after intrathoracic anastomosis is low (4/142 cases: 2.8%), accurate diagnosis is difficult, and decision for highly difficult treatment, including reoperation (3 cases), must be made immediately. The incidence after cervical anastomosis was relatively high (6/56 cases: 10.7%), but 5 cases (83.3%) could be cured by conservative treatment. As a treatment option, enteral nutrition using jejunostomy is highly useful, in addition to redo–surgery, appropriate drainage from outside/inside the gastrointestinal tract and antimicrobial administration. When AF develops after esophagectomy for cancer, it is important to perform timely, individualized treatment and nutritional care in consideration of each patient’s condition as well as the reconstruction method and disease condition.

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  • Ryo Tanaka, Sang–Woong Lee, Yoshiro Imai, Kotaro Honda, Keitaro Tanaka ...
    2020 Volume 17 Issue 2 Pages 75-81
    Published: April 30, 2020
    Released: May 25, 2020
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    【Introduction】 The feasibility of using the enhanced recovery after surgery (ERAS) program in patients with gastric cancer remains unclear. We evaluated the safety and efficacy of the ERAS protocol in such patients.【Methods】 This study was a single–center, prospective randomized trial on patients with gastric cancer undergoing curative gastrectomy. The primary end point was the length of postoperative hospital stay. Secondary end points were the postoperative complication rate, readmission rates and weight loss.【Results】 From July 2013 to June 2015, we randomized 148 patients into an ERAS group (n=73) and a conventional group (n=69); six patients withdrew. The completion rates of the protocol were 87.7 % for the ERAS group and 81.2 % for the conventional group. Postoperative hospital stay in the ERAS group was significantly shorter than that in the conventional group (9 vs. 10 days; P=0.037). The ERAS group had a significantly lower rate of postoperative complications grade Ⅲ or higher (4 vs. 15 per cent; P=0.042). The ratio of body weight to preoperative weight at postoperative week 1 and at 1 month was higher in the ERAS group (0.962 vs. 0.957, P=0.020; and 0.951 vs. 0.937, P=0.021, respectively).【Conclusion】 The ERAS program shortened the postoperative hospital stay after gastric cancer surgery, reduced the rate of complications and accelerated the recovery of good physical condition.

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  • Tomoharu Miyashita, Tetsuo Ohta, Daisuke Matsui, Koji Nishijima, Fumio ...
    2020 Volume 17 Issue 2 Pages 82-88
    Published: April 30, 2020
    Released: May 25, 2020
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    The gut barrier plays an essential role in maintaining host homeostasis. The barrier regulates nutrient absorption as well as prevents the invasion of pathogenic bacteria in the host. It is composed of epithelial cells, tight junctions, and a mucus layer. Several factors, such as perioperative fasting, antimicrobial therapy and surgical invasion can affect this barrier. These factors have been shown to increase intestinal permeability, inflammation, and translocation of pathogenic bacteria. Bacterial Translocation into portal blood from the small and large intestine with reduced gut barrier function has influence to liver dysfunction. Therefore, enhancing the gut barrier function may play a central role of therapy because target organ is gut in perioperative period. We have devised the combined therapy with Glutamine/BCAA and synbiotics in the perioperative period for patients undergoing high risk surgery or causing intra–abdominal infections. We concluded that this bundle therapy which improving the gut environment during the perioperative period may prevent the perioperative surgical complication.

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