C. B. FEATHER1, A. Boord1, L. Antognoli1, J. Turcotte1, J. R. Klune1 1Anne Arundel Medical Center,Acute Care Surgery, Department Of Surgery,Annapolis, MARYLAND, USA
Introduction: Emergency open large bowel procedures have higher rates of intraoperative contamination and increased risk of surgical site infection (SSI) compared to elective open colorectal surgical procedures. Wound complications can affect length of stay, wound healing, and need for further intervention. Several options for wound management exist, but it remains unclear how variability of wound closure techniques impact incidence of SSI and other complications. The purpose of this study is to investigate how varying methods of wound closure techniques in open emergency colon surgery impact incidence of SSI and length of stay.
Methods: This is a retrospective review of patients undergoing open emergency colon surgery from January 2017 to December 2018. The primary outcome measure was incidence of SSI. Secondary outcome measures included length of stay and rate of re-operation and 30-day readmission. Patients were stratified both by wound closure techniques and procedure type for analysis. Univariable and multivariable analysis were performed.
Results: A total of 118 patients were included in the study, with mean age of 62.8 years and mean BMI of 28.4. Overall incidence of surgical site infection was 16.1%. There was no significant difference in incidence of SSI when stratifying by wound closure technique (skin staples, skin stapled with intermittent packing, skin open with VAC application, and delayed primary closure) or procedure type (appendectomy only, right colon, left colon, other), even after controlling for variables such as age, sex, BMI, race, and wound classification. There was no significant difference in rate of return to OR or 30-day readmission. Furthermore, patients managed with wound VAC had a statistically significant longer average length of stay (20.5 days vs. 10.8-13.3 days, p=0.009) and higher total post-operative antibiotics days (12.3 days vs. 5.7-8.6 days, p=0.001) compared to all other wound management techniques.
Conclusion: Type of surgery and wound management technique did not affect rates of SSI. Patients managed by wound VAC had increased length of stay and post-operative antibiotic duration. These findings would suggest that there is no advantage to a particular wound management technique in this patient population. Furthermore, some wound management techniques, such as VAC management, might lead to an increased length of stay and antibiotic duration. Consequences of this may include increase in morbidity and increase total hospital cost, both of which could be explored in future studies on this subject.