Ogawa Katsuhiro, Nitta Hidetoshi, Masuda Toshiro, Matsumoto Katsutaka, Okino Tetsuya, Miyamoto Yuji, Baba Hideo, Takamori Hiroshi
Division of Surgery Saiseikai Kumamoto Hospital Kumamoto Japan.
Department of Gastroenterological Surgery Graduate School of Life Science Kumamoto University Kumamoto Japan.
Acute Med Surg. 2021 Feb 9;8(1):e633. doi: 10.1002/ams2.633. eCollection 2021 Jan-Dec.
Surgical-site infections (SSIs) often occur after surgery for colorectal perforation. We introduced delayed primary closure (DPC) after intrawound continuous negative pressure and irrigation treatment (IW-CONPIT) to prevent SSIs. We aimed to evaluate the efficacy of DPC after IW-CONPIT compared with primary closure (PC) after surgery for colorectal perforation.
We undertook a retrospective study including 22 patients who underwent DPC (DPC group) and 18 patients who underwent PC (PC group) at our hospital between April 2015 and January 2017. The primary outcome was the SSI rate. The secondary outcomes were other complications (<30 days), length of hospital stay, and costs.
The SSI rate was significantly lower in the DPC group than in the PC group (40% vs. 94%, = 0.0006). Moreover, superficial and deep incisional SSIs, infectious complications, and Clavien-Dindo classification grade ≥ 2 complications were also significantly diminished in the DPC group. Conversely, the length of hospital stay and costs were not significantly different between the two groups. Multivariate analyses revealed that the significant independent protective factor against SSI after surgery for colorectal perforation was DPC after IW-CONPIT (odds ratio 0.04; 95% confidence interval, 0.002-0.25).
Delayed primary closure after IW-CONPIT reduced SSIs after surgery for colorectal perforation compared with PC.
结直肠穿孔手术后常发生手术部位感染（SSIs）。我们在伤口内持续负压和冲洗治疗（IW-CONPIT）后采用延迟一期缝合（DPC）来预防SSIs。我们旨在评估IW-CONPIT后DPC与结直肠穿孔手术后一期缝合（PC）相比的疗效。
我们进行了一项回顾性研究，纳入了2015年4月至2017年1月期间在我院接受DPC的22例患者（DPC组）和接受PC的18例患者（PC组）。主要结局是SSI发生率。次要结局是其他并发症（<30天）、住院时间和费用。
DPC组的SSI发生率显著低于PC组（40%对94%，P = 0.0006）。此外，DPC组的浅表和深部切口SSIs、感染性并发症以及Clavien-Dindo分类≥2级并发症也显著减少。相反，两组之间的住院时间和费用没有显著差异。多变量分析显示，结直肠穿孔手术后预防SSI的显著独立保护因素是IW-CONPIT后的DPC（优势比0.04；95%置信区间，0.002-0.25）。
与PC相比，IW-CONPIT后的延迟一期缝合降低了结直肠穿孔手术后的SSIs。
