Backgrounds: Traditional percutaneous catheter drainage (PCD) does not always achieve satisfactory therapeutic effects in patients with severe acute pancreatitis (SAP) complicated by infected pancreatic necrosis (IPN). We modified the conventional PCD therapy by employing Trocar-assisted percutaneous abscess drainage (TA-PAD) combined with double-lumen catheter negative-pressure irrigation and drainage for the treatment of patients with SAP with IPN and compared its efficacy with that of traditional PCD. Patients and Methods: Retrospective analysis of clinical data from patients with SAP complicated with IPN at Jinling Hospital between June 2018 and February 2024. Patients were divided by procedure into two treatment groups: the modified TA-PAD with negative-pressure irrigation group and the conventional PCD group, for comparative efficacy analysis. Results: Among the 74 patients, Comparison between the TA-PAD (n = 48) and PCD (n = 26) groups confirmed that TA-PAD was superior, yielding a lower mortality rate (12.5% vs. 34.6%, p = 0.024), shorter hospitalization (p = 0.006), reduced costs (p = 0.01), fewer re-interventions (20.8% vs. 57.7%, p < 0.001), and fewer catheters required (1 (1–2) vs. 2 (1–2.25), p = 0.029). Furthermore, the TA-PAD group demonstrated more significant improvements in infection markers, including body temperature, C-reactive protein, and white blood cell count. Conclusion: The modified TA-PAD procedure combined with double-lumen catheter negative-pressure irrigation and drainage significantly outperformed conventional PCD in treating patients with SAP with IPN. The study demonstrates significant reductions in mortality, hospital stay, treatment costs, and procedural burden, alongside a superior resolution of infection markers within one week post-intervention.
Background: Appropriate statistical methodology and transparent reporting are essential for the validity and reproducibility of research. Despite landmark guidance from the American Statistical Association (ASA), inadequate statistical reporting remains common in surgical literature. We examined whether the nature and quality of statistical reporting in the Surgical Infections journal changed between 2015 and 2023. Methods: A retrospective review of original research articles published in Surgical Infections in 2015 compared to 2023 was performed. The methods and results sections of included articles were reviewed for: reporting of a priori significance level (α), power calculation performance and methodology, p-value reporting modalities, confidence interval use, and claims of statistical significance. Dichotomous variables were compared using Fisher exact test, continuous variables by Student’s t-test, and variances by F-statistic. Results: A total of 102 (2015) and 86 (2023) articles met inclusion criteria. Power calculations were reported in only 11.7% of articles overall, with no significant change between years (p = 0.25). Reporting of α decreased from 79.4% to 67.4% (p = 0.07), with near-uniform convergence to p < 0.05 in 2023 (86% vs. 98%; p = 0.01). The number of unique p-value reporting modalities increased between years, with one 2023 article employing 15 distinct modalities. Confidence-interval reporting was unchanged (58.9% vs. 61.6%; p = 0.6). Claims of statistical significance decreased from 92.2% to 79.1% of articles (p = 0.01). Conclusions: Statistical reporting in Surgical Infections showed little improvement from 2015 to 2023 despite evolving national guidance. Fewer authors claimed significance, and the journal demonstrated no requirement for significance for publication. We recommend standardized statistical-reporting guidelines.
Primary necrotizing fasciitis (NF) of the breast is a rare, life-threatening soft tissue infection that is frequently misdiagnosed due to its non-specific early presentation and uncommon anatomical location.We report a case of primary NF of the breast to highlight the diagnostic challenges posed by atypical risk factors and the critical importance of timely surgical intervention and antibiotic cover.A 66-year-old female presented with breast pain, erythema, and systemic symptoms in the setting of hidradenitis suppurativa (HS) being treated with adalimumab and long-standing tobacco use. Clinical assessment, laboratory investigations, and computed tomography (CT) imaging were performed, followed by surgical exploration.Initial concerns included abscess formation, cellulitis, or a HS flare. However, clinical instability and CT imaging demonstrated a gas-filled structure in the medial left breast with a developing gas-filled collection. Surgical exploration revealed extensive necrotising fasciitis involving the medial quadrant of the inner breast and underlying fascia, necessitating emergent surgical debridement and broad-spectrum antimicrobial therapy. The patient required further debridement and wound management, followed by delayed reconstruction.This case illustrates how underlying risk factors, particularly immunosuppression, may predispose patients to atypical presentations of NF and reinforces the importance of early surgical and antibiotic intervention when clinical suspicion is high.
BACKGROUND:Extended post antibiotics do not reduce infectious complications after traumatic facial injuries or elective clean-contaminated head and neck operation. However, the optimal duration of antibiotic prophylaxis following operative repair of traumatic neck aerodigestive injuries remains uncertain. This study compared outcomes between perioperative (≤24 hours) and extended (>24 hours) antibiotic prophylaxis and hypothesized that extended prophylaxis would not reduce local infectious complications. METHODS:Using a Level I and II university-based trauma system registry, patients undergoing operative repair of traumatic neck aerodigestive injuries (oropharynx, hypopharynx, larynx, esophagus, and trachea) were identified over an 8-year period (2017-2024). Demographics, injury characteristics, management strategies, and antibiotic use were collected. Patients were stratified by antibiotic prophylaxis duration (perioperative vs. extended). The primary outcome was local infectious complications. Secondary outcomes included leak, stenosis, reintervention, length of stay, and mortality. RESULTS:Sixty-five patients with operative penetrating or blunt neck aerodigestive injuries were identified: 35 received perioperative antibiotics and 30 received an extended course. Most injuries were penetrating (93.8%). Extended antibiotics were prescribed more frequently in older patients (40.5 vs. 29 years, p < 0.01), while injury characteristics and adjunctive management strategies were otherwise similar. Local infectious complication rates did not differ significantly between the perioperative and extended antibiotic groups (5.7% vs. 20%, p = 0.13). Rates of leak, stenosis, reintervention, length of stay, and mortality were also similar. No patient, injury, or management factor was associated with local infectious complications. CONCLUSIONS:Extended post antibiotic prophylaxis was not associated with lower infection rates or improved clinical outcomes following operative repair of traumatic neck aerodigestive injuries. Prospective multicenter studies are needed to validate these findings and refine antibiotic protocols for these injuries.
