Objective: Vertebral osteomyelitis is an uncommon illness; adults are mostly affected. Our objective is to evaluate the short term outcome of oral versus parenteral antimicrobials treatment for pyogenic (nontuberculous and non-brucellosis) vertebral osteomyelitis, and the best invasive diagnostic method yielding a microbiological diagnosis. Methods: The medical records were reviewed in a retrospective study for patients ≥ 18 years old from five urban hospitals within Amman-Jordan; two teaching and three primary care hospitals, during the period between August 1999 to June 2007. Due to the small numbers in the arm of antimicrobials treatment, tstudents’ test was used to assess inferences like 95% confidence interval and p-values for the difference among treatment arms. Results: Seventy-four medical records were available, inpatients records 35 from two teaching hospitals, 39 records from three primary care hospitals. The orally treated patients showed lack of difference against the parenteral therapy group at the end of 6 weeks therapy (p > 0.05). Diagnostic methods tested for microbiological diagnosis were as follows; True cut biopsy, fine needle aspiration and limited laminectomy did not differ significantly in their microbiological diagnostic ability. Our data suggested lack of difference between oral and parenteral therapy groups at the end of six weeks treatment, but a questionable tendency (95% CI; -0.11 to 0.64, p= 0.08). The diagnostic ability of the three methods did not suggest significant differences (p >0.05), except for true cut biopsy versus fine needle aspiration where it showed tendency (95% CI; - 0.20 to 0.42, p= 0.07). Conclusion: The key to successful management is the early diagnosis, and bone sampling for microbiological examination, allowing proper antimicrobial selection. A proper bone sampling method is important to evaluate, especially in the absence of surgical indication and the co-notation in some parts of the world that M. tuberculosis is the most -if not the sole- pathogen in vertebral osteomyelitis.
Abstract Background The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. Methods Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. Results Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). Conclusion Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery.
The Esophagectomy Complications Consensus Group (ECCG) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA) have set standards in reporting outcomes after oesophagectomy. Reporting outcomes from selected high-volume centres or centralized national cancer programmes may not, however, be reflective of the true global prevalence of complications. This study aimed to compare complication rates after oesophagectomy from these existing sources with those of an unselected international cohort from the Oesophago-Gastric Anastomosis Audit (OGAA).The OGAA was a prospective multicentre cohort study coordinated by the West Midlands Research Collaborative, and included patients undergoing oesophagectomy for oesophageal cancer between April and December 2018, with 90 days of follow-up.The OGAA study included 2247 oesophagectomies across 137 hospitals in 41 countries. Comparisons with the ECCG and DUCA found differences in baseline demographics between the three cohorts, including age, ASA grade, and rates of chronic pulmonary disease. The OGAA had the lowest rates of neoadjuvant treatment (OGAA 75.1 per cent, ECCG 78.9 per cent, DUCA 93.5 per cent; P < 0.001). DUCA exhibited the highest rates of minimally invasive surgery (OGAA 57.2 per cent, ECCG 47.9 per cent, DUCA 85.8 per cent; P < 0.001). Overall complication rates were similar in the three cohorts (OGAA 63.6 per cent, ECCG 59.0 per cent, DUCA 62.2 per cent), with no statistically significant difference in Clavien-Dindo grades (P = 0.752). However, a significant difference in 30-day mortality was observed, with DUCA reporting the lowest rate (OGAA 3.2 per cent, ECCG 2.4 per cent, DUCA 1.7 per cent; P = 0.013).Despite differences in rates of co-morbidities, oncological treatment strategies, and access to minimal-access surgery, overall complication rates were similar in the three cohorts.
Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.
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