Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Department of Surgery, University of Utah, Salt Lake City, Utah.
J Surg Res. 2019 Jun;238:90-95. doi: 10.1016/j.jss.2019.01.040. Epub 2019 Feb 12.
Groin hernia repairs (GHR), though classified as clean surgeries, are associated with varying rates of surgical site infections. We assessed the practices of surgeons in Ghana regarding antibiotic use for GHR in comparison to evidence-based international guidelines (EBIG).
We interviewed surgeons trained by the Ghana College of Physicians and Surgeons (GCPS), from inception (2003) through 2016, about their use of antibiotics for GHR. We defined the outcome variable of consistently following EBIG in antibiotics use for GHR. Logistic regression was used to examine how a priori selected covariates contributed to the outcome.
Eighty-two of 117 surgeons reported performing/supervising at least one GHR per week. They performed/supervised a mean of five GHR per week. Thirty-two (40%) reported using mesh for at least 50% of GHR. For primary GHR, 75% of surgeons administered antibiotics according to EBIG, whereas for GHR with mesh only, 45% did so. Predictors of consistently following EBIG were increasing number of GHR performed per week (adjusted odds ratio 1.44, 95% CI 1.07-1.96) and increasing time spent for clinical work (adjusted odds ratio 0.95, 95% CI 0.91-0.99). Years of practice since GCPS graduation, total operations performed per week, and hospital level of practice were not predictive of the outcome variable.
Two-thirds of Ghanaian surgeons interviewed do not consistently administer antibiotics for GHR per EBIG, raising the need to improve access to evidence-based medical information overall to guide practice. Determining local surgical site infections rates to guide antibiotic use in GHR will be useful in Ghana and other LMICs.
腹股沟疝修补术（GHR）虽然被归类为清洁手术，但与不同的手术部位感染率有关。我们评估了加纳外科医生在 GHR 中使用抗生素的做法，并将其与循证国际指南（EBIG）进行了比较。
我们对加纳内科医师和外科医师学院（GCPS）培训的外科医生进行了访谈，从 2003 年开始到 2016 年，了解他们在 GHR 中使用抗生素的情况。我们将始终遵循 EBIG 治疗 GHR 中抗生素使用的结果变量定义为一致。使用逻辑回归来检查预先选择的协变量如何影响结果。
82 名外科医生中有 117 名报告每周至少进行/监督一次 GHR。他们平均每周进行五次 GHR。32 名（40％）报告至少 50％的 GHR 使用网片。对于原发性 GHR，75％的外科医生根据 EBIG 使用抗生素，而对于仅使用 GHR 的外科医生，45％的外科医生这样做。始终遵循 EBIG 的预测因素是每周进行的 GHR 数量增加（调整后的优势比 1.44，95％CI 1.07-1.96）和临床工作时间增加（调整后的优势比 0.95，95％CI 0.91-0.99）。GCPS 毕业后的从业年限，每周进行的总手术次数以及医院的实践水平均不能预测该结果变量。
接受采访的加纳外科医生中有三分之二没有根据 EBIG 始终为 GHR 开抗生素，这表明需要改善获取循证医学信息的途径，以指导实践。确定当地手术部位感染率以指导 GHR 中的抗生素使用在加纳和其他 LMIC 国家将非常有用。
