Does Wound Management Technique Impact Surgical Site Infection in Open Emergency Colon Procedures?

Abstract

Background Emergency open large bowel procedures have higher rates of intraoperative contamination and increased risk of surgical site infection (SSI) than elective colon surgeries. Several wound management strategies have been proposed, such as vacuum-assisted closure (VAC) therapy and delayed primary closure to improve results. The purpose of this study is to evaluate the relationship between wound management technique and SSI and other quality measures. Methods We performed a retrospective review of patients undergoing open emergency colon surgery from January 2017 to December 2018 by our acute care surgery service. The primary outcome measure was incidence of SSI. Secondary outcome measures included length of stay, reoperation, and 30-day readmission. Results A total of 118 patients were included in the study, with a mean age of 62.8 years and mean BMI of 28.8. Overall incidence of SSI was 19.5%. There was no significant difference in incidence of SSI, reoperation, or 30-day readmission when stratifying by wound management technique or procedure type after controlling for confounding variables. Notably, patients managed with VAC therapy had a statistically significant longer average length of stay and higher total postoperative antibiotic days (both P = .001) than other techniques. Discussion We conclude from our data that wound management technique does not seem to influence rate of SSI, but wound management may influence length of stay or antibiotic duration. These findings suggest that there may not be an advantage to alternative methods of wound management in this high-risk population. Further prospective evaluation should be performed to confirm these findings.

Revisión bibliográfica: Infección de herida quirúrgica: profilaxis y tratamiento

“…La infección de la herida quirúrgica dependerá del tipo de incisión (Mahmud et al,2022), incisiones superficiales que se manifiestan 30 días después de la cirugía y que involucran la piel y el tejido subcutáneo, con los siguientes requisitos: drenaje purulento, eliminación de microorganismos, fluidos o tejidos corporales e inflamación, dolor, enrojecimiento y fiebre, son signos clínicos que advierten infección (Zhao et al, 2022;Oliveira et al, 2022;Turcotte et al,2022).…”

O enfermeiro no pós-operatório imediato de apendicectomia na unidade de recuperação pós-anestésica: uma revisão integrativa

“…A equipe de enfermagem também orienta sobre os sinais de complicações que devem ser relatados imediatamente, como febre persistente, intensa ou direção anormal na incisão. Essa educação ajuda o paciente a tomar medidas preventivas e a buscar assistência médica quando necessário (TURCOTTE et al, 2022).…”

Open and Closed Approaches to Skin Closure After Nonelective Open Colorectal Operations

“…While various approaches to leaving skin open-including intermittent closure with wicks, VAC therapy, and DPC-have been cited as potential mechanisms for reducing SSIs, they have not been evaluated in a comprehensive fashion. 9 Further, these approaches may result in increased morbidity and resource utilization as they require ongoing management until final closure is performed. The results of the current study suggest that primary closure of all layers remains a viable approach to wound management in NOCS patients, as evidenced by the similar deep SSI rates and favorable morbidity and mortality in comparison to the skin open cohort.…”

“…5 Further, a variety of approaches to leaving skin open including intermittent closure with wicks, negative pressure vacuum (VAC) therapy, and delayed primary closure (DPC) exist, and comprehensive comparison of these approaches has not been performed. 9 Conflicting conclusions regarding the optimal closure technique in the NOCS population have been reached. Multiple national observational studies have found no difference in deep SSI rate between skin open and primary closure, 1,10 including in contaminated and dirty/ infected wounds, 10 while others have identified a protective effect of delayed primary closure in preventing various types of SSIs in a variety of open abdominal surgeries, [11][12][13] although the quality of this evidence remains low.…”