Barrier Wound Protection Decreases Surgical Site Infection in Open Elective Colorectal Surgery: A Randomized Clinical Trial

Reid, Kate; Pockney, Peter; Draganic, Brian; Smith, Stephen R.

doi:10.1007/dcr.0b013e3181ed3f7e

Cited by 99 publications

(92 citation statements)

References 18 publications

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“…Success of our bundle may be explained by the inclusion of wound protector use, which has a major impact on superficial component of SSI. 30 On the other hand, reported benefits of minimally invasive vs. open surgical approach were also supported by our findings. The present study is limited by some aspects of its design.…”

Section: Discussionsupporting

confidence: 87%

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Rencüzoğulları¹,

Trunzo²,

Vogel³

et al. 2018

TJCD

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Aim: Applying prevention bundles to all patients to reduce surgical site infections (SSI) after colorectal surgery is expensive and has minimal success. The aim of this study was to identify factors associated with high-risk of superficial SSI and to assess the impact of prevention measures on high-risk patients. Method: Between January 2010 and February 2014, patients who underwent colorectal surgical procedures were separated into the pre-bundle period (January 2010-July 2012) and bundle period (August 2012-February 2014. Factors associated with superficial SSI risk were evaluated. Pre-bundle and bundle patients were categorized in deciles from low-to high-risk using a risk model. The impact of prospectively introduced protective measures was assessed in the bundle patients with multivariate modeling and frequency-matched analysis. Results: There were 2.535 pre-bundle patients who underwent ileocolic (19.1%), left-sided (46%), and pelvic (34.9%) procedures. Overall superficial SSI rate was 10.7%. Four patient-related factors and five procedure-related factors were found to be significantly associated with superficial SSI on unadjusted analysis. Comparison of pre-bundle patients on whom the risk model was built and the bundle patients used in the risk assessment showed significant decrease in superficial SSI rates (10.6% to 3.2%, p<0.001). Frequency matched analysis demonstrated a significant reduction in superficial SSI from pre-bundle to bundle patients (13.1 to 4.2%, p<0.001). Among the risk deciles in bundle patients, the reduction from the average predicted risk to the observed superficial SSI rate was most evident among the high-risk groups. Conclusion: Preventive strategies specifically aimed at patients with the highest risk for superficial SSI after colorectal surgery resulted in the highest reduction. Considering the variability of SSI rates, collaborative and targeted policies are critical to ensure efficacious and potentially cost-effective strategies. Keywords: Superficial surgical site infection, prevention bundle, colorectal surgery, high-risk patients Amaç: Kolorektal cerrahi sonrası cerrahi alan enfeksiyonlarını (CAE) azaltmak için hazırlanan önlem paketlerinin tüm hastalara uygulanması pahalı olup minimal başarıya sahiptir. Bu çalışmada yüksek riskli yüzeyel CAE'leri ile ilişkili faktörler ve koruyucu önlemlerin yüksek riskli hastalardaki etkinliğini değerlendirmek amaçlanmıştır. Yöntem: 2010 Ocak ve 2014 Şubat tarihleri arasında kolorektal eksizyon uygunlanan hastalar önlem demeti öncesi (2010 Ocak-2012 Ağustos) ve demet dönemi (2012 Ağustos-2014 Şubat) olmak üzere identifiye edildi. Yüzeyel CAE riski ile ilişkili faktörler değerlendirildi. Demet öncesi ve demet dönemi periyoduna ait hastalar risk modeli oluşturularak 1/10'luk gruplar şeklinde düşük riskten yüksek riske doğru kategorize edildi. Demet dönemi periyoduna ait hastalara prospektif olarak uygulanan koruyucu önlemlerin etkisi çok değişkenli modelleme ve frekans-eşlemeli analiz ile değerlendirildi. Bulgular: İleokolik (%19,1)...

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Section: Discussionsupporting

confidence: 87%

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Rencüzoğulları¹,

Trunzo²,

Vogel³

et al. 2018

TJCD

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“…After the study selection process, 12 studies were included in the review [34][35][36][37][38][39][40][41][42][43][44][45] (Fig. 2).…”

Section: Study Selectionmentioning

confidence: 99%

Systematic Review of the Clinical Effectiveness of Wound-edge Protection Devices in Reducing Surgical Site Infection in Patients Undergoing Open Abdominal Surgery

Gheorghe¹,

Calvert²,

Pinkney³

et al. 2012

Annals of Surgery

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“…The risk factors for SSI limited to laparoscopic colon resection have been reported to include increased BMI and a history of DM (11)(12)(13). Wound retractors can prevent infection after laparoscopic colorectal procedures, indicating that the methods and instruments used are important (14,15). In our department, the incidence of ANTICANCER RESEARCH 38: 513-517 (2018) 514 transumbilical wound SSI in LAC was 4.3% (15/348).…”

Section: Discussionmentioning

confidence: 84%

Evaluation of a Transumbilical Incision as an Approach for Organ Removal in Laparoscopy-assisted Colectomy

Tomioka

Murakami

Watanabe

et al. 2018

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Abstract. Aim: To investigate the risk factors of transumbilical incision for organ removal in laparoscopyassisted colectomy (LAC).In laparoscopic surgery, a transumbilical incision is often used for anastomosis and organ removal. In our Department, we have been performing transumbilical incisions to remove resected organs since shortly after the introduction of laparoscopic surgery. We vertically extend the umbilical wound corresponding to the size of the specimen and anastomose extracorporeally. We have already reported that surgical site infection (SSI) and hernia occurred at a significantly higher rate in colorectal resection than in gastric resection in laparoscopic surgery. Additionally, we showed that female sex and diabetes mellitus (DM) were independent risk factors in relation to hernia (1).The present study aimed to evaluate the complication rates and risk factors associated with transumbilical incisions in laparoscopy-assisted colectomy (LAC). Patients and MethodsThis study included a cohort of 417 consecutive patients who underwent LAC for colorectal cancer at

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Barrier Wound Protection Decreases Surgical Site Infection in Open Elective Colorectal Surgery: A Randomized Clinical Trial

Abstract: In this study the use of barrier wound protection in elective open colorectal resectional surgery resulted in a clinically significant reduction in incisional surgical site infections. Barrier wound protection of this nature should be considered routine in this type of surgery.

Cited by 99 publications

References 18 publications

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Superficial Surgical Site Infection after Colorectal Surgery: Targeting High-Risk Patients Increases the Efficacy of Prevention Bundles

Systematic Review of the Clinical Effectiveness of Wound-edge Protection Devices in Reducing Surgical Site Infection in Patients Undergoing Open Abdominal Surgery

Evaluation of a Transumbilical Incision as an Approach for Organ Removal in Laparoscopy-assisted Colectomy

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