Incisional Surgical Site Infection after Abdominal Fascial Closure with Triclosan-Coated Barbed Suture vs Triclosan-Coated Polydioxanone Loop Suture vs Polydioxanone Loop Suture in Emergent Abdominal Surgery: A Randomized Clinical Trial

Ruíz-Tóvar, Jaime; Llavero, Carolina; Jiménez-Fuertes, Montiel; Durán, Manuel; Pérez-López, Mercedes; Marín, Andrés García

doi:10.1016/j.jamcollsurg.2020.02.031

Cited by 35 publications

(48 citation statements)

References 33 publications

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“…Peponis examined the correlation between closure techniques and the rate of SSI, comparing interrupted fascial closure 16.2% versus continuous fascial closure 12.2% [38]. Ruiz-Tovar then studied the effects of closure sutures on deep SSI rates, comparing triclosan-coated barbed suture 6.4% with the control of polydioxanone loop suture 16.3% [40]. Phelan and his cohort of 83 patients, examined the rate of SSI with bundles 26.7% and without bundles 28.3% [39].…”

Section: Bundle Element Resultsmentioning

confidence: 99%

“…Our technical closure group showed a non-significant reduction of 15% in SSI rates (3.55%, 54/1521) compared to the control group (8.64%, 54/625) (RR = 0.85; CI, 0.57-1.26; p = 0.41) (Figure 4). There was a moderate level of heterogeneity between trials (I 2 = 42%) [33][34][35]38,40].…”

Section: Discussionmentioning

confidence: 98%

“…Frazee examined incisional negative pressure wound therapy (iNPWT) on open and closed wounds; with the small numbers in this trial, it was found to be insignificant [35]. Ruiz-Tovar found that triclosan coated barbed suture was more effective against polydioxanone loop suture, but was found to be insignificant [40].…”

Section: Discussionmentioning

confidence: 98%

“…Following leave-one-out sensitivity analysis, it was shown after leaving out Dayama's study that our technical closure bundle became significant and showing a reduction in SSI of 36% (RR = 0.64; CI, 0.41-0.99; p = 0.05) ( Figure 5). The meta-analysis of the five grouped abdominal wall closure studies are limited by their small number and heterogenicity [33][34][35]38,40]. Dayama examined complete skin closure versus skin-open [33].…”

Section: Discussionmentioning

confidence: 99%

“…In Peponis (n = 78) it is unable to determine gender and age numbers and the primary indications found for surgery were small bowel obstruction, colonic perforation and C. difficile colitis [38]. Ruiz-Tovar's group of 139 had a similar median age cohort of 65, 79 of which were male patients, and patients underwent surgery for bowel obstruction, perforated diverticulitis, perforated neoplasm and acute bowel ischemia [40]. Lastly, in Yamamoto's collection (n = 72), with a median age of 72, 37 males partook in the trial and all of the operations performed were for colorectal perforation [41].…”

Section: Patient Demographics and Surgery Indicationmentioning

confidence: 99%

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Systematic Review and Meta-Analysis of Wound Bundles in Emergency Midline Laparotomy Identifies That It Is Time for Improvement

McGeehan

Edelduok

Bucholc

et al. 2021

Life

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Background: Emergency midline laparotomy is the cornerstone of survival in patients with peritonitis. While bundling of care elements has been shown to optimize outcomes, this has focused on elective rather than emergency abdominal surgery. The aim of this study was to undertake a systematic review and meta-analysis of factors affecting the development of surgical site infection (SSI) in patients undergoing midline emergency laparotomy. Methods: An ethically approved, PROSPERO registered (ID: CRD42020193246) meta-analysis and systematic review, searching PubMed, Scopus, Web of Science and Cochrane Library electronic databases from January 2015 to June 2020 and adhering to PRISMA guidelines was undertaken. Search headings included “emergency surgery”, “laparotomy”, “surgical site infection”, “midline incision” and “wound bundle”. Suitable publications were graded using Methodological Index for Non-Randomised Studies (MINORS); papers scoring ≥16/24 were included for data analysis. The primary outcome in this study was SSI rates following the use of wound bundles. Secondary outcomes consisted of the effect of the individual interventions included in the bundles and the SSI rates for superficial and deep infections. Five studies focusing on closure techniques were grouped to assess their effect on SSI. Results: This study identified 1875 articles. A total of 58 were potentially suitable, and 11 were included after applying MINORS score. The final cohort included 2,856 patients from eight countries. Three papers came from the USA, two papers from Japan and the remainder from Denmark, England, Iran, Netherlands, Spain and Turkey. There was a 32% non-significant SSI reduction after the implementation of wound bundles (RR = 0.68; CI, 0.39–1.17; p = 0.16). In bundles used for technical closure the reduction in SSI of 15% was non-significant (RR = 0.85; CI, 0.57–1.26; p = 0.41). Analysis of an effective wound bundle was limited due to insufficient data. Conclusions: This study identified a significant deficit in the world literature relating to emergency laparotomy and wound outcome optimisation. Given the global burden of emergency general surgery urgent action is needed to assess bundle’s ability to potentially improve outcome after emergency laparotomy.

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Section: Bundle Element Resultsmentioning

confidence: 99%