Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Surgery. 2023 Aug;174(2):291-295. doi: 10.1016/j.surg.2023.04.018. Epub 2023 May 12.
Surgical site infections after gastrointestinal perforation with peritonitis have significant morbidity, increased hospital stays, and cost of treatment. The appropriate management of these wounds is still debatable.
Patients undergoing surgery for gastrointestinal perforation with peritonitis via midline incision were screened for inclusion. After the closure of the midline fascia, patients were randomized into an open negative pressure wound therapy group (application of negative pressure wound therapy and attempted delayed closure at day 4) or a standard care group (no negative pressure wound therapy and attempted delayed closure at day 4). Postoperative outcomes, including surgical site infection till 30 days, were compared between the groups. This was assessed by an independent assessor not involved in the study for delayed closure. Although a priori sample size was calculated, an interim analysis was performed due to slow recruitment during the COVID pandemic. After interim analysis, a continuation of the trial was deemed unethical and terminated.
Ninety-six patients were assessed, and 69 were randomized (34 in the negative pressure wound therapy group and 31 in the standard care group). The age, body mass index, comorbidities, blood loss, operative time, and stoma formation were comparable. The surgical site infection was significantly lower in the negative pressure wound therapy group compared to the standard care group (6 [18%] vs 19 [61%], P < .01). The number needed to prevent 1 surgical site infection was 2.3. In a subgroup analysis, the use of negative pressure wound therapy also significantly decreased the rate of surgical site infection in stoma patients (4 [30.7%] vs 9 [69.3%], P = .03).
Open negative pressure wound therapy significantly decreases the incisional surgical site infection rate in patients with a dirty wound secondary to gastrointestinal perforation with peritonitis.
胃肠道穿孔合并腹膜炎患者术后发生切口感染会显著增加发病率、住院时间和治疗费用。这些伤口的适当处理仍存在争议。
筛选接受正中切口手术治疗的胃肠道穿孔合并腹膜炎患者，纳入研究。在关闭中线筋膜后，将患者随机分为开放式负压伤口治疗组（应用负压伤口治疗并在第 4 天尝试延迟闭合）或标准护理组（不应用负压伤口治疗并在第 4 天尝试延迟闭合）。比较两组术后结果，包括术后 30 天内的切口感染情况。延迟闭合情况由不参与本研究的独立评估人员进行评估。虽然预先计算了样本量，但由于 COVID 大流行期间招募缓慢，进行了中期分析。中期分析后，继续进行试验被认为不道德，并终止了试验。
共评估了 96 例患者，其中 69 例随机分组（负压伤口治疗组 34 例，标准护理组 31 例）。年龄、体重指数、合并症、出血量、手术时间和造口形成情况相当。与标准护理组相比，负压伤口治疗组的切口感染发生率显著降低（6 [18%] vs 19 [61%]，P <.01）。预防 1 例切口感染所需的人数为 2.3。亚组分析显示，负压伤口治疗还显著降低了造口患者的切口感染率（4 [30.7%] vs 9 [69.3%]，P =.03）。
开放性负压伤口治疗可显著降低胃肠道穿孔合并腹膜炎导致的脏污伤口患者的切口感染发生率。
