TY - JOUR
T1 - To close or not to close? Wound management in emergent colorectal surgery, an EAST multicenter prospective cohort study
AU - Feather, Cristina B.
AU - Rehrig, Scott
AU - Allen, Rebecca
AU - Barth, Nadine
AU - Kugler, Emmalee M.
AU - Cullinane, Daniel C.
AU - Falank, Carolyne R.
AU - Bhattacharya, Bishwajit
AU - Maung, Adrian A.
AU - Seng, Sirivan
AU - Ratnasekera, Asanthi
AU - Bass, Gary Alan
AU - Butler, Dale
AU - Pascual, Jose L.
AU - Srikureja, Daniel
AU - Winicki, Nolan
AU - Lynde, Jennifer
AU - Nowak, Brittany
AU - Azar, Faris
AU - Thompson, Lauren A.
AU - Nahmias, Jeffry
AU - Manasa, Morgan
AU - Tesoriero, Ronald
AU - Kumar, Sandhya B.
AU - Collom, Morgan
AU - Kincaid, Michelle
AU - Sperwer, Kimberly
AU - Santos, Ariel P.
AU - Klune, J. Robert
AU - Turcotte, Justin
N1 - Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2024/7/1
Y1 - 2024/7/1
N2 - BACKGROUND This study aimed to determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS), and mortality in emergent colorectal surgery. METHODS A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS, and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, intensive care unit admission, vasopressor use, procedure details, and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates. RESULTS In total, 557 patients were included (SC, n = 262; SLC, n = 124; SO, n = 171). Statistically significant differences in body mass index, race/ethnicity, American Society of Anesthesiologist scores, EBL, intensive care unit admission, vasopressor therapy, procedure details, and wound class were observed across groups. Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group. After risk adjustment, SO was associated with increased risk of mortality (OR, 3.003; p = 0.028) in comparison with the SC group. Skin loosely closed was associated with increased risk of superficial SSI (OR, 3.439; p = 0.014), after risk adjustment. CONCLUSION When compared with the SC group, the SO group was associated with mortality but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
AB - BACKGROUND This study aimed to determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS), and mortality in emergent colorectal surgery. METHODS A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS, and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, intensive care unit admission, vasopressor use, procedure details, and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates. RESULTS In total, 557 patients were included (SC, n = 262; SLC, n = 124; SO, n = 171). Statistically significant differences in body mass index, race/ethnicity, American Society of Anesthesiologist scores, EBL, intensive care unit admission, vasopressor therapy, procedure details, and wound class were observed across groups. Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group. After risk adjustment, SO was associated with increased risk of mortality (OR, 3.003; p = 0.028) in comparison with the SC group. Skin loosely closed was associated with increased risk of superficial SSI (OR, 3.439; p = 0.014), after risk adjustment. CONCLUSION When compared with the SC group, the SO group was associated with mortality but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
KW - Colorectal surgery
KW - emergency general surgery
KW - skin closure
KW - surgical site infection
KW - wound management
UR - https://www.scopus.com/pages/publications/85197412271
U2 - 10.1097/TA.0000000000004321
DO - 10.1097/TA.0000000000004321
M3 - Article
C2 - 38523130
AN - SCOPUS:85197412271
SN - 2163-0755
VL - 97
SP - 73
EP - 81
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 1
ER -