Department of Surgery, Baylor Scott & White Health - Texas A&M, Temple, Texas.
Department of Surgery, University of Rochester - Strong Memorial Hospital, Rochester, New York.
J Surg Res. 2021 Sep;265:64-70. doi: 10.1016/j.jss.2021.02.054. Epub 2021 Apr 20.
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.
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.
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.
The novel IWP device shows promise to reducing the risk of SSI in elective colorectal surgery.
由于术中结肠细菌暴露于手术部位，择期结肠直肠手术的手术部位感染（SSI）发生率仍然很高。我们旨在评估一种新型伤口牵开器在择期结肠直肠切除术中的 30 天 SSI 结果，该牵开器将屏障保护与持续伤口冲洗相结合。
回顾性单中心队列匹配分析包括 2015 年 4 月至 2019 年 7 月期间使用新型冲洗伤口保护器（IWP）进行择期结肠直肠切除术的所有患者。同时确定了在同一时间段内接受相同手术但使用标准伤口保护器的患者的对照队列。两组患者均根据手术类型、手术入路、需要手术的病理、年龄、性别、种族、体重指数、糖尿病、吸烟状况、高血压、弥散性癌症的存在、当前类固醇或免疫抑制剂的使用、伤口分类和美国麻醉医师协会分类进行匹配。通过术后 30 天记录 SSI 频率、SSI 亚型（浅表、深部或器官间隙）、住院时间（LOS）和相关手术。Fisher 确切检验和需要治疗的人数（NNT）用于比较两组的 SSI 发生率和估计成本。
IWP 组有 41 例患者。对照组有 82 例患者。两组的对照匹配变量相似。IWP 组的 30 天 SSI 发生率明显较低（P=0.0298）。IWP 组的住院时间明显缩短（P=0.0150）。IWP 预防 1 例 SSI 的 NNT 为 8.2 例。
新型 IWP 装置有望降低择期结肠直肠手术中 SSI 的风险。
