World Congress on Surgeons November 22-23, 2018 Bucharest, Romania

Dr Sunny Dhadlie is a Health Practitioners - Medical Practitioner licensed to practice in Australia.

Introduction: \r\nSepsis is a leading cause of critical illness and mortality worldwide. There is now an increasing awareness of the long-term physical, psychological and cognitive disabilities in patients who survive sepsis. Furthermore, there are significant health care and social implications. \r\nSepsis is defined as life threatening organ dysfunction secondary to a dysregulated host response to infection. For clinical operationalization the Sequential (Sepsis-related) Organ Failure Assessment (SOFA) score of 2 or more points represents organ dysfunction.1 \r\nThe Surviving Sepsis Campaign2 has incorporated the 3 and 6-hour bundles previously defined into an Hour-1 bundle to facilitate prompt identification and management of patients with suspected sepsis.\r\n\r\nObjective: \r\nAnalyse timing of antibiotic delivery for patients with suspected intra-abdominal sepsis from time of arrival in the Emergency Department and the correlation with clinical outcomes. \r\n\r\nDesign: \r\n12-month retrospective study of patients admitted with intra abdominal source of sepsis from 1st April 2017 to and inclusive of 31st March 2018. \r\n\r\nPatients: \r\n1060 were found to have intra abdominal pathology, 27 of which had intra abdominal sepsis. 55% were female. Patient age ranged between 7 to 97 years with mean body mass index (BMI) 27.\r\n\r\nResults:\r\nThe mean time of antibiotic delivery was within 4 hours (range 1 to 22 hours). The mean length of admission was 9 days (range 3 to 21 days). 89% of patients were commenced on appropriate broad-spectrum antibiotics. 7% of patients had a bacteremia with one-third of patients requiring an Intensive Care Unit (ICU) admission. 60% of patients required emergency operative intervention. There were no mortalities reported.\r\n\r\nConclusion:\r\nThe target of delivery for broad-spectrum antibiotics was not within 1 hour2 for two thirds of the patients admitted. This highlights a need for education around implementation of a sepsis bundle in the emergency department with a quality indicator set to enable feedback to modify clinician behavior related to early management of sepsis\r\n

Dr Sunny Dhadlie is a Health Practitioners - Medical Practitioner licensed to practice in Australia.

Introduction: \r\nOpen mesh ventral hernia repair is a common procedure performed by general surgeons.\r\nRecent meta-analysis comparing in lay to on lay mesh repairs demonstrated a lower frequency of surgical site infection with in lay repairs. There was no difference in the rate of recurrence or seroma formation.1\r\nVentral hernias and the complications from repair can significantly affect an individual’s quality of life and have health care implications in relation to prolonged admissions and readmissions. 2,3\r\n\r\nObjective: \r\nAnalyse the number of readmissions within 30 days of open primary ventral hernia mesh repair and the associated complications. \r\n\r\nDesign: \r\nRetrospective study of patients who had a primary ventral hernia mesh repairs that were readmitted within 30 days of the procedure between 1st May 2015 to and inclusive of 31st May 2018.\r\n\r\nPatients: \r\n312 patients had primary ventral hernia repairs (including umbilical hernia mesh repairs). 71 were readmitted within 30 days of their procedure, 29 of which had complications related to the procedure. 41% patients were male.\r\n\r\nResults:\r\n80% of readmission had an on lay repair. The mean length of readmission was 2 days. The mean time to readmission was 16 days (range 1 to 30 days). \r\nThe mean age of patients was 51 (range 31 to 84 years). 30% of patients had type 2 diabetes, vascular disease or obesity. Complications were attributed to haematomas (17%), infected seromas (73%) and wound infection (10%). There was a return to theatre in 34% cases. Polypropylene (prolene) mesh was used in 60% of cases.\r\n\r\nConclusion:\r\nInfected seromas as complication of on lay mesh repair was the most frequent readmission. There are several factors that are known to affect the risk of developing incisional hernia and contribute to poor outcomes post hernia repair such as age, obesity, infection, diabetes and smoking.3 Only one-third of patients had these comorbidities which suggest that the technique of repair has more impact on the complication rate.\r\n\r\n