Bukhari Ishtiyaq, Afzal Zeeshan, Judkins Nicholas, Summers Dominic M, Dennis Robert
Department of Surgery, Peterborough City Hospital, Peterborough, GBR.
Department of Surgery, University of Cambridge, Cambridge, GBR.
Cureus. 2023 Jul 11;15(7):e41708. doi: 10.7759/cureus.41708. eCollection 2023 Jul.
Superficial surgical site infection (SSI) is a common morbidity following bowel resection surgery involving stoma formation with clinical and financial implications. The study aimed to evaluate the role of topical skin adhesive, 2-octylcyanoacrylate (Dermabond®) (2-OCA) in reducing wound infections following colorectal stoma surgery.
We performed a retrospective, single-centre, cohort study using clinical notes. All patients, over the age of 18, undergoing bowel resection either elective or emergency, with stoma formation over five years from January 2015 to December 2019 were included. The primary endpoint was SSI, defined by the clinical manifestation of inflammation including pain, erythema, and discharge, regardless of the microbiological culture results. Patients received either 2-OCA glue as wound dressing or standard firm adhesive wound dressing e.g. Opsite.
Overall, 604 patients were included in the study. The median age was 67; 187 (31%) patients received Dermabond (Group 1) and 417 (69%) received standard care (Group 2). A total of 288 (47%) patients were female, 134 (22%) had body mass index (BMI) greater than 30, 87 (14%) were diabetic, and 90 (15%) were smokers. A total of 279 (46%) patients had an American Society of Anesthesiologists (ASA) score of 3 and 4; 282 (47%) patients went through emergency surgery, 279 (64%) patients underwent dirty surgery, and 220 (35%) patients developed SSI. BMI greater than 30 compared to < 30 (OR: 2.32, 95% CI: 1.54-3.49, p<0.0001), diabetes compared to no diabetes (OR: 0.54, 95% CI: 0.32-0.92, p<0.0241), dirty surgery compared to clean surgery (OR: 2.26, 95% CI: 1.51-3.37, p<0.0001) and standard care, no 2-OCA glue use compared to the use of 2-OCA glue (OR: 1.52, 95% CI: 1.03-2.24, p=0.0343) were associated with SSIs. Conclusion: Our study demonstrates that there is an association between 2-OCA and reduced SSIs in bowel resection surgery involving stoma formation when compared to standard methods of wound dressing. Further randomised clinical trials are recommended to strengthen this evidence and demonstrate causation.
浅表手术部位感染（SSI）是肠切除造口术后常见的并发症，具有临床和经济影响。本研究旨在评估局部皮肤粘合剂2-氰基丙烯酸辛酯（商品名Dermabond®，简称2-OCA）在降低结直肠造口术后伤口感染中的作用。
我们使用临床记录进行了一项回顾性、单中心队列研究。纳入2015年1月至2019年12月期间所有年龄在18岁以上、接受择期或急诊肠切除并造口的患者。主要终点是SSI，根据炎症的临床表现定义，包括疼痛、红斑和分泌物，无论微生物培养结果如何。患者接受2-OCA胶水作为伤口敷料或标准的牢固粘性伤口敷料，如Opsite。
总体而言，604例患者纳入研究。中位年龄为67岁；187例（31%）患者接受了Dermabond（第1组），417例（69%）接受了标准护理（第2组）。共有288例（47%）患者为女性，134例（22%）体重指数（BMI）大于30，87例（14%）患有糖尿病，90例（15%）为吸烟者。共有279例（46%）患者美国麻醉医师协会（ASA）评分为3分和4分；282例（47%）患者接受了急诊手术，279例（64%）患者接受了污染手术，220例（35%）患者发生了SSI。BMI大于30与小于30相比（比值比：2.32，95%置信区间：1.54-3.49；p<0.0001），糖尿病与无糖尿病相比（比值比：0.54，95%置信区间：0.32-0.92；p<0.0241），污染手术与清洁手术相比（比值比：2.26，95%置信区间：1.51-3.37；p<0.0001），以及标准护理、未使用2-OCA胶水与使用2-OCA胶水相比（比值比：1.52，95%置信区间：1.03-2.24；p=0.0343）均与SSI相关。结论：我们的研究表明，与标准伤口敷料方法相比，在涉及造口形成的肠切除手术中，2-OCA与降低SSI之间存在关联。建议进一步进行随机临床试验以加强这一证据并证明因果关系。
