Lorenz William R, Ricker Ansley B, Holland Alexis M, Polcz Monica E, Scarola Gregory T, Kercher Kent W, Augenstein Vedra A, Heniford B Todd
Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Department of Surgery, Baptist Health South Florida, Miami, FL, USA.
Surg Endosc. 2025 Feb;39(2):1283-1289. doi: 10.1007/s00464-024-11420-7. Epub 2024 Dec 6.
Wound complications (WC) after abdominal wall reconstruction (AWR) are associated with increased cost, recurrence, and mesh infection. Operative closing protocols (CP) have been studied in other surgical disciplines but not in AWR. Our aim was to study the effect of a CP on WC after AWR.
The CP consists of antibiotic wound irrigation, glove and complete instrument exchange, and re-draping of the sterile field to cover the skin entirely prior to mesh implantation. A prospective institutional database at a tertiary hernia center was queried for patients who underwent open AWR with mesh. Standard descriptive and inferential statistics are reported. A Bayesian structured time-series analysis was performed to evaluate rates of wound infection (WI) and WC before and after implementation of a CP in late 2016.
A total of 2541 AWR patients were examined. Mean age and BMI were 57.9 ± 12.6 years and 32.9 ± 9.8 kg/m, 56.7% were female, and 24.2% were diabetic. Significantly more CP patients had contaminated wounds. Mean defect size was 203.1 ± 205.8 cm. Average follow-up was 31.5 ± 41.4 months. WI rate before CP (preCP) was 14.5% compared to 2.6% after CP (P < 0.001). WC rate was higher before CP (29.3% vs 10.3%, P < 0.001). Specifically, wound cellulitis (9.7% vs 2.7%, P < 0.001), wound infection (13.8 vs 1.8%, P < 0.001), and mesh infection (2.1% vs 0.6%, P < 0.004) rates were reduced after CP implementation. For WI, Bayesian Structured time-series analysis showed that the implementation of CP had an effect of 83% (± 2%, 95% CI - 87%, - 78%; P < 0.001) reduction in WI compared to counterfactual. For WC, the Bayesian analysis revealed a reduction compared to counterfactual for WC of - 67% (± 3%, 95% CI - 60%, - 72%; P < 0.001).
Introduction of a CP for open AWR with mesh has reduced overall WI and WC rates. The use of a CP should be strongly considered in AWR.
腹壁重建（AWR）术后的伤口并发症（WC）与成本增加、复发及补片感染相关。手术闭合方案（CP）已在其他外科领域进行了研究，但在AWR中尚未开展。我们的目的是研究CP对AWR术后WC的影响。
CP包括抗生素伤口冲洗、更换手套和全套器械，以及在植入补片前重新铺无菌巾以完全覆盖皮肤。查询一家三级疝中心的前瞻性机构数据库，以获取接受开放式带补片AWR的患者。报告标准的描述性和推断性统计数据。进行贝叶斯结构化时间序列分析，以评估2016年末实施CP前后的伤口感染（WI）率和WC率。
共检查了2541例AWR患者。平均年龄和BMI分别为57.9±12.6岁和32.9±9.8kg/m²，56.7%为女性，24.2%患有糖尿病。接受CP治疗的患者伤口污染明显更多。平均缺损大小为203.1±205.8cm²。平均随访时间为31.5±41.4个月。CP实施前（preCP）的WI率为14.5%，而CP实施后为2.6%（P<0.001）。CP实施前的WC率更高（29.3%对10.3%，P<0.001）。具体而言，CP实施后伤口蜂窝织炎（9.7%对2.7%，P<0.001）、伤口感染（13.8%对1.8%，P<0.001）和补片感染（2.1%对0.6%，P<0.004）率均有所降低。对于WI，贝叶斯结构化时间序列分析表明，与反事实情况相比，CP的实施使WI降低了83%（±2%，95%CI -87%，-78%；P<0.001）。对于WC，贝叶斯分析显示与反事实情况相比，WC降低了-67%（±3%，95%CI -60%，-72%；P<0.001）。
引入用于开放式带补片AWR的CP降低了总体WI和WC率。在AWR中应强烈考虑使用CP。
