Association between incisional surgical site infection and the type of skin closure after stoma closure

Kobayashi, Shin; Ito, Masaaki; Sugito, Masanori; Kobayashi, Akihiro; Nishizawa, Yusuke; Saitô, Norio

doi:10.1007/s00595-010-4405-y

Cited by 20 publications

(14 citation statements)

References 18 publications

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“…Studies on the subject show contradictory results. In the retrospective study by Kobayashi et al [19] , wound infection rate was as high as 23.5%, and subcuticular sutures apparently showed a protective effect. However, very recent studies and RCTs on wound closure, report purse-string sutures to achieve a 0% infection rate compared to other methods, thus not recommending linear closure of stoma wounds [20,21] .…”

Section: Discussionmentioning

confidence: 95%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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AIM:To study the morbidity and complications associated to ileostomy reversal in colorectal surgery patients, and if these are related to the time of closure. METHODS:A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance. RESULTS:The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy creation was rectal cancer (56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the patients, with 1% mortality. The most frequent were ileus (13%) and wound infection (13%). Pseudomembranous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomy closure (P = 0.041). Male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003). End-to-end intestinal anastomosis without resection was significantly associated with postoperative ileus (P = 0.037). CONCLUSION:Although closure of a protective ileostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Protective ileostomy; Stomas; Stoma-related complications; Surgical infections; Colorectal surgery Core tip: Protective ileostomies are widely used by surgeons for the protection of anastomoses, but they imply a second intervention for reversal. Despite being considered a minor intervention, ileostomy reversal does not lack complications. Adjuvant treatment, complications from the first intervention, or low-priority consideration can delay the closure of the stoma. In our study, we reviewed all complications following ileostomy reversal and found they were considerably high (40%), and increased as did the time (in months) until closure (P = 0.041). In multivariate analysis, male patients had more complications (P = 0.042), mainly wound infections (P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure (P = 0.003).Rubio-Perez I, Leon M, Pastor D, Diaz Dominguez J, Cantero R. Increased postoperative complications after protective ileostomy closure delay: An institutional study. World J Gastrointest Surg 2014; 6(9): 169-174 Available from:

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Section: Discussionmentioning

confidence: 95%

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Rubio-Perez¹,

León²,

Pastor³

et al. 2014

WJGS

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“…We reported a 22% rate of stoma site SSI, which is within the range of 8-38% that is reported among studies that use similar CDC guideline definitions [9,10,15]. Studies that predate the CDC guidelines reported a wider range from 2 to 41%, which may reflect the variation in SSI definition before the guidelines were established.…”

Section: Discussionmentioning

confidence: 61%

Prevalence of Surgical Site Infection at the Stoma Site following Four Skin Closure Techniques: A Retrospective Cohort Study

Brahmbhatt

Hicks

et al. 2014

Dig Surg

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Background/Aims: Surgical site infection (SSI) is a common complication of stoma reversal. Studies have suggested that different skin closures affect SSI rates. Our aim was to determine which skin closure technique following stoma reversal leads to the lowest rate of SSI. Methods: We conducted a retrospective review of all adult patients undergoing stoma reversal at a single institution (2005-2011) and compared the rate of SSI following four skin closure techniques: primary closure (PC), secondary closure (SC), loose PC (LPC), and circular closure (CC). Univariate analysis included χ² or Fisher's exact test and ANOVA or Kruskal-Wallis H test for categorical and continuous data, respectively. A multivariate logistic regression model was created to identify predictors of SSI. Results: One hundred and forty-six patients were identified: 40 (27%) PC, 68 (47%) SC, 20 (14%) LPC, and 18 (12%) CC. CC was less likely to have SSI (6%) compared to PC (43%), SC (16%), and LPC (15%; p < 0.01). Increasing body mass index was a predictor of SSI (odds ratio 1.11, 95% confidence interval 1.04-1.12, p < 0.01). CC was associated with the lowest odds of developing SSI [0.07 (0.01-0.63), p = 0.02]. Conclusions: SSI rate was the lowest for stomas that were closed with CC.

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“…Although the mechanism underlying the protective impact of subcuticular suture against SSI are not clear, previous studies have reported that there is a statistically higher blood flow in wounds sutured with subcuticular technique than in those with skin staples or mattress stitches, and buried suture strings beneath the surface of the skin prevent subcutaneous dead space and excessive tissue inflammation [35,36]. In association with the skin closure, skin staples are often employed because of shorter operation time.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Surgical Site Infection after Hepatectomy for Liver Disease

Shimada¹,

Ueno²,

Iino³

et al. 2014

UCMS

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Abstract:The incidence of postoperative SSI (surgical site infection) after hepatic resection has decreased gradually with the refinement of surgical techniques and perioperative management. However, postoperative SSI still develops in a few patients after hepatic resection, leading to increased medical costs, longer hospitalization and a reduced quality of life in the postoperative course. The purpose of this study was to analyze the risk factors of SSI and to assist in predicting the occurrence of SSI after hepatic resection. A retrospective analysis of 227 patients who underwent hepatic resection without biliary reconstruction for liver disease between January 2006 and December 2012 was performed. Patients were divided into two groups according the occurrence of SSI. The association between SSI and various clinical parameters was investigated. Nineteen patients developed SSI: 9 with superficial or deep SSI and 10 with organ/space SSI. In univariate analysis, preoperative platelets, aspartate aminotransferase and alanine aminotransferase concentrations, intraoperative blood loss, perioperative transfusion, procedure of skin closure, and postoperative bile leakage differed statistically between the two groups. Patients with SSI required significantly longer hospitalization than those without SSI. In multivariate analysis, conventional skin closure and postoperative bile leakage were the significant risk factors. It is important to prevent bile leakage to reduce postoperative SSI. Moreover, subcuticular suture for skin closure would be effective in preventing incisional SSI. Continuous efforts should be made to prevent SSI and further study is needed to develop additional new strategies for preventing SSI.

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Association between incisional surgical site infection and the type of skin closure after stoma closure

Abstract: A subcuticular skin closure has a protective effect against incisional SSI after closure of diverting stoma. A larger study is necessary to further define the role of subcuticular suture on the prevention of incisional SSI in cases of gastrointestinal surgery.

Cited by 20 publications

References 18 publications

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Increased postoperative complications after protective ileostomy closure delay: An institutional study

Prevalence of Surgical Site Infection at the Stoma Site following Four Skin Closure Techniques: A Retrospective Cohort Study

Risk Factors Associated with Surgical Site Infection after Hepatectomy for Liver Disease

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