Developing a Scoring System to Determine Necessity and Timing of Surgical Intervention in the Treatment of Cellulitis
Narayana Subramaniam,
Bharati V. Hiremath,
Balakrishna M. Naik
Issue:
Volume 3, Issue 2, April 2015
Pages:
8-11
Received:
18 February 2015
Accepted:
7 March 2015
Published:
13 March 2015
Abstract: Aim: To develop a clinico-pathological scoring system to determine necessity and timing of surgical intervention in cellulitis. Introduction: Cellulitis is a major cause of morbidity, however standard plan of care and treatment guidelines are far from standardized. Our study was done to determine the clinical and pathological markers indicating the need for surgical intervention and derivation of a scoring system. Materials and methods: Cross-sectional prospective observational study of 148 patients of cellulitis presenting to M.S. Ramaiah Hospitals between Jan. 2012 and 2014. Based on clinical judgement they were divided into two groups – those who required surgical intervention and those who did not. All cases were evaluated in terms of clinical and pathological characteristics. These parameters were compared in the two groups and the clinical and laboratory findings that were altered to a degree of statistical significance in those undergoing surgical intervention were noted; the relative risk ratio for surgical intervention of each was taken as a component of the final scoring system. Results: The physical and biochemical parameters found to have a statistically significant correlation with surgical intervention – percentage of area involved (p<0.001), skin necrosis (p<0.001), stretch pain (p<0.001), chronic kidney disease (p<0.002), diabetes mellitus (p<0.002), hyponatremia (p<0.006) and degree of elevation in total count (p<0.001). These were used to derive the scoring system. Low risk was <5 points and high risk >10 points. Conclusion: This scoring system may be helpful to determine necessity and timing of surgical intervention in cellulitis, especially when to end trial of conservative management. Additionally it may provide risk stratification for prognostic value.
Abstract: Aim: To develop a clinico-pathological scoring system to determine necessity and timing of surgical intervention in cellulitis. Introduction: Cellulitis is a major cause of morbidity, however standard plan of care and treatment guidelines are far from standardized. Our study was done to determine the clinical and pathological markers indicating the...
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The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs
Jesús Lago Oliver,
Salvador Argudo Garijo,
Mauricio Burneo Estéves,
Marta Cuadrado Ayuso,
Fernando Turégano Fuentes,
Araceli Casado Gómez
Issue:
Volume 3, Issue 2, April 2015
Pages:
12-17
Received:
30 March 2015
Accepted:
14 April 2015
Published:
30 April 2015
Abstract: Objective: To analyse hospital costs in the pre-, and intra- and post-operative periods associated with patients undergoing rectal resection with anastomosis, comparing the costs per patient with and without the use of fibrin-based biological adhesive(Tissucol Duo®). Methods: The cost analysis was designed with a subsample of 37 patients who underwent rectal anastomosis in a randomised, single-blind, controlled, parallel comparison between two groups, to evaluate the effectiveness of fibrin-based biological adhesive used to prevent anastomotic leakage. The total costs included diagnostic tests, laboratory tests, hospital stay, adhesive cost, surgery, reintervention and drug treatment. Results: The patients had a mean age of 64.33 years, with a higher proportion of men (62.2%). The study groups were homogeneous and comparable. The average total cost in the group with biological adhesive was€ 10,304.84 compared to € 17,845.12 in the group without biological adhesive. Significant differences were found in the average cost of reintervention between groups: € 119.76 with adhesive vs. € 639.20 for the control group. Conclusions: The total cost decreased by 42% in the group in which a biological adhesive was applied compared to the group in which the adhesive was not applied. This percentage represented a difference of € 7,540.28 in the total average cost per patient.
Abstract: Objective: To analyse hospital costs in the pre-, and intra- and post-operative periods associated with patients undergoing rectal resection with anastomosis, comparing the costs per patient with and without the use of fibrin-based biological adhesive(Tissucol Duo®). Methods: The cost analysis was designed with a subsample of 37 patients who underw...
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