Initial Outcomes of a Novel Irrigating Wound Protector for Reducing the Risk of Surgical Site Infection in Elective Colectomies

Abstract

Background: Surgical site infection (SSI) rates in elective colorectal surgery remain high due to intraoperative exposure of colonic bacteria at the surgical site. We aimed to evaluate 30-day SSI outcomes of a novel wound retractor that combines barrier protection with continuous wound irrigation in elective colorectal resection. Materials and methods:A retrospective single-center cohort-matched analysis included all patients undergoing elective colorectal resection utilizing the novel irrigating wound protector (IWP) from April 2015 to July 2019. A control cohort of patients who underwent the same procedures with a standard wound protector over the same time period were also identified.Patients from both groups were matched for procedure type, procedure approach, pathology requiring operation, age, sex, race, body mass index, diabetes, smoker status, hypertension, presence of disseminated cancer, current steroid or immunosuppressant use, wound classification, and American Society of Anesthesiologist classification. SSI frequency, SSI subtype (superficial, deep, or organ space), hospital length of stay (LOS) and associated procedure were tabulated through 30 postoperative days. Fisher's exact test and number needed to treat (NNT) were used to compare SSI rates and estimate cost between both groups.Results: The IWP group had 41 patients. The control group had 82 patients. Control-matched variables were similar for both groups. 30-day SSI rates were significantly lower in the IWP group ( P = 0.0298). length of stay was significantly shorter in the IWP group ( P = 0.0150). The NNT for the IWP to prevent one episode of SSI was 8.2 patients. Conclusions:The novel IWP device shows promise to reducing the risk of SSI in elective colorectal surgery.

Effect of wound irrigation on the prevention of surgical site infections: A meta‐analysis

“…Though some in‐vitro studies 39,40 have shown a negative outcome of povidone‐iodine on tissue regeneration, some old studies label serum iodine toxicity as an outcome of irrigation 41,42 . Though, these adverse effects cannot be validated in clinical trials 13‐36 . When considering antibiotics, however, our results favour its use, the bactericidal influence of most agents needs a contact time.…”

“…A total of 1867 distinctive studies were found, of which 24 studies (between 1979 and 2021) satisfied the inclusion criteria and were comprised in the study. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 This meta‐analysis study based on 24 studies included 4967 subjects under surgery at the start of the study; antibiotic irrigation was used with 1372 of them, 1261 were aqueous povidone‐iodine irrigation, and 2334 were saline irrigation or no irrigation for surgical site infections prevention in all surgical populations. All studies evaluated the effect of wound irrigation on the prevention of surgical site infections.…”

“…This meta‐analysis study based on 24 studies included 4967 subjects under surgery at the start of the study; antibiotic irrigation was used with 1372 of them, 1261 were aqueous povidone‐iodine irrigation, and 2334 were saline irrigation or no irrigation for surgical site infections prevention in all surgical populations 13‐36 . Antibiotic irrigation and aqueous povidone‐iodine irrigation had significantly lower surgical site infections in all surgical populations compared with saline irrigation or no irrigation for the subject under surgery.…”

“…Many studies have shown that prophylactic incisional irrigation with different antibiotics or aqueous povidone‐iodine solution has a significant value on the surgical site infection, mainly in clean and clean‐contaminated wounds, however, no dose‐response effect was detected 13‐36 . In addition, some other studies have shown a significant effect on surgical site infection was observed when used with force or using pulse pressure, nevertheless not with regular irrigation.…”

Rastreamento de complicações em cirurgias realizadas por vídeo

“…Pacientes com história clínica de diabetes, imunossupressão, associados a fatores correlatos como ambiente e a utilização restrita de técnica estéril, o ambiente e o tempo de cirurgia pode incidir em maiores riscos (SCHWARTZMAN; KHACHEMOUNE, 2021). Os processos multifatoriais incluem, as infecções do sítio cirúrgico que permanecem como um sério agravo, com aumento na morbidade, tempo de internação hospitalar, readmissões, aumento dos custos hospitalares (MALEK et al, 2021).…”