Reduction of Postoperative Wound Infections by Antiseptica (RECIPE)?

Abstract

Objective: To evaluate whether intraoperative subcutaneous wound irrigation with 0.04% polyhexanide can reduce surgical site infection (SSI) in elective laparotomies compared to saline. Background: SSI is a common complication after gastrointestinal surgery. To date, there is a lack of evidence whether subcutaneous wound irrigation is beneficial in terms of reduction of SSI. Methods: The RECIPE trial was an investigator initiated single-center, single-blind prospective, randomized controlled trial with 2 parallel treatment groups, comparing wound irrigation with 0.9% saline to antiseptic 0.04% polyhexanide solution in elective laparotomies. Primary endpoint was the rate of SSI within 30 days postoperatively according to Centers for Disease Control and Prevention criteria. Results: Between February 02, 2015, and May 23, 2018, 456 patients were randomly assigned to saline (n = 228) or polyhexanide (n = 228). Final cohort for analysis comprised 393 patients (202 in the saline and 191 in the polyhexanide group). Overall rate of SSI was 28.2%, n = 111. Simple analysis with cross tabulation revealed that significantly fewer SSIs occurred in the polyhexanide group: n = 70 (34.7%) versus n = 41 (21.5%); P = 0.004. In a multiple logistic regression model the factor wound irrigation with polyhexanide [odds ratio (OR) 0.44; 95% confidence interval (CI) 0.27–0.72; P = 0.001) was associated with risk reduction of SSI. Preoperative anemia (OR 2.08; 95% CI 1.27–3.40; P = 0.004) and more than 5 prior abdominal operations compared to none (OR 8.51; 95% CI 2.57–28.21; P < 0.001) were associated with SSI. Conclusions: Intraoperative subcutaneous wound irrigation with antiseptic 0.04% polyhexanide solution is effective in reducing SSI after elective laparotomies.

The impact of surgical site infection—a cost analysis

“…In the RECIPE trial (Reduction of postoperative wound infections by antiseptica?) conducted in the Department of General, Visceral and Vascular Surgery of the Charité -Campus Benjamin Franklin Berlin, we could show that intraoperative subcutaneous wound irrigation with polyhexanide reduces SSI in elective laparotomies compared to wound irrigation with saline [6].…”

“…In the RECIPE trial, SSI was defined according to the criteria by the Centers for Disease Control and Prevention within 30 days postoperatively (Table 1) [6]. Examination of the wound at least every second day, regularly dressing changes, and decision, if SSI was present, were performed [16] Superficial incisional SSI Infection occurs within 30 days after the operation AND Involves only skin and subcutaneous tissue of the incision AND patient has at least one of the following: 1.…”

“…The RECIPE trial was a single-center, randomized controlled, prospective trial with two treatment groups comparing intraoperative subcutaneous wound irrigation with 250 ml of 0.04% polyhexanide solution (Serasept2®, Serag-Wiessner, Naila, Germany) to 250 ml of 0.9% saline in elective open or laparoscopically assisted abdominal surgery. The primary outcome data -rate of SSI 30 days postoperatively -was published previously [6]. Here, we report a post hoc analysis of this prospectively collected cohort analyzing the impact of SSI on inpatient costs and 30-day postoperative outcome.…”

“…Patients 18 years or older, capable to give informed consent, and undergoing elective open or laparoscopically assisted abdominal surgery were eligible to participate. Patients were randomly assigned either to the control group with 0.9% saline or to the experimental group with 0.04% polyhexanide solution [6].…”

Impact of wound irrigation during laparoscopic appendectomy on surgical site infection in acute appendicitis: a multicenter retrospective analysis

“…Povidone-iodine (PI) irrigation during spinal surgery signi cantly reduced the SSI rate compared to saline irrigation [7]. In abdominal surgery, subcutaneous wound irrigation with 0.04% polyhexanide solution signi cantly reduced SSI [8]. Moreover, 0.05% chlorhexidine gluconate irrigation reduced SSI after loop ileostomy closure [9].…”