Comparison of skin closure techniques in patients undergoing open pancreaticoduodenectomy: A single center experience

Flick, Katelyn F.; Simpson, Rachel E.; Soufi, Mazhar; Fennerty, Mitchell L.; Yip-Schneider, Michele; Colgate, Cameron L.; Ceppa, Eugene P.; House, Michael G.; Zyromski, Nicholas J.; Nakeeb, Attila; Schmidt, C.M.

doi:10.1016/j.amjsurg.2020.02.023

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…As expected, those requiring more extensive care after discharge did experience complications more frequently, however when the population is evaluated as a whole, complication rates are well within normal, accepted rates within the literature (delayed gastric emptying 13%, pancreatic fistula 13%, and incisional surgical site infection 12%). In addition, previous studies from our institution have reflected on surgical practices that highlight these postoperative complications and measures taken to reduce them [31][32][33]. This suggests that the patient cohort is 'higher risk' as identified by the preoperative nomogram and less likely due to quality of surgical technique employed by the surgeons who all have high volume experience in hepato-pancreato-biliary surgery.…”

Section: Discussionmentioning

confidence: 97%

Preoperative Nomogram Predicts Non-home Discharge in Patients Undergoing Pancreatoduodenectomy

Flick

Schmidt

Colgate

et al. 2021

Journal of Gastrointestinal Surgery

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Background:In patients undergoing pancreatoduodenectomy, non-home discharge is common and often results in an unnecessary delay in hospital discharge. This study aimed to develop and validate a preoperative prediction model to identify patients with a high likelihood of non-home discharge following pancreatoduodenectomy. Methods:Patients undergoing pancreatoduodenectomy from 2013-2018 were identified using an institutional database. Patients were categorized according to discharge location (Home vs. Non-Home). Preoperative risk factors, including social determinants of health associated with nonhome discharge, were identified using Pearson's chi-squared test and then included in a multiple logistic regression model. A training cohort composed of 80% of the sampled patients was used to create the prediction model, and validation carried out using the remaining 20%. Statistical significance was defined as P < 0.05. Results:766 pancreatoduodenectomy patients met the study criteria for inclusion in the analysis (nonhome: 126; home: 640). Independent predictors of non-home discharge on multivariable analysis were age, marital status, mental health diagnosis, functional health status, dyspnea, and chronic obstructive pulmonary disease. The prediction model was then used to generate a nomogram to predict likelihood of non-home discharge. The training and validation cohorts demonstrated comparable performances with an identical area under the curve (0.81) and an accuracy of 84%. Conclusion:A prediction model to reliably assess the likelihood of non-home discharge after pancreatoduodenectomy was developed and validated in the present study.

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Section: Discussionmentioning

confidence: 97%

Preoperative Nomogram Predicts Non-home Discharge in Patients Undergoing Pancreatoduodenectomy

Flick

Schmidt

Colgate

et al. 2021

Journal of Gastrointestinal Surgery

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“…The combination of MBP and antibiotic (PO) preparation is recommended for all elective colectomies according to ACS and SIS guidelines [77]. Other surgical techniques such as quilting or killing the dead space to reduce seroma and the use of subcuticular suturing should be looked at with increasing evidence that these may reduce wound infection rates [80,81]. This paper did not specifically look at laparoscopic versus open colorectal surgery and this is something that will need to be done into the future, stratifying cohorts or having separate or comparative studies [82].…”

Section: Discussionmentioning

confidence: 99%

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

2022

J Surg

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Background: Surgical Site Infections (SSI) are a major source of post-operative complications and potentially affect oncological outcomes. Reducing SSI is multi-factorial, best served by the additive affect of individual wound bundle elements. With changing strategies and novel innovations ongoing meta-analyses are needed to inform current practice. This study undertook a meta-analysis of existing wound bundles impact on SSI in colorectal surgery.Methods: A PROSPERO-registered (ID: CRD42018104923) meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using databases PubMed, Scopus and Web of Science, from January 2008 to July 2018, was undertaken. Articles scoring ≥ 17 using Methodological Index for non-randomised Studies (MINORS) criteria were included.Results: 5,104 articles were reviewed, and 27 studies met inclusion criteria with a total cohort of 23851 patients. Wound bundles significantly decreased SSI rates from 17.5% to 9.7%. Sub-analysis identified greatest impact on superficial SSI (risk reduction of 54%; p<0.00001) and organ-space infections (risk reduction 42%; p=0.0006).Wound bundles also significantly reduced hospital length of stay (MD = −0.79; p<0.00001). Conclusions:Colorectal wound bundles significantly reduce the risk of SSI and length of hospital stay. They should become routine in colorectal surgery. Future work encompasses the need for standardisation of wound complications, standardised follow-up of patients and internationally agreed research definitions.

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“…A comparative analysis suggested that adhesives are effective and better than staples in managing wounds related to incisional surgical site complications. [ 10 ] Similarly, 2OCA was found to be more effective than sutures in another study. [ 11 ] Clinically relevant characteristics have also been evaluated for different skin adhesives that are currently being used routinely, and these adhesives were found to be suitable.…”

Section: Introductionmentioning

confidence: 91%

“…2OCA skin adhesives are effective and superior for many applications. A comparative analysis suggested that adhesives are effective and better than staples in managing wounds related to incisional surgical site complications [10] . Similarly, 2OCA was found to be more effective than sutures in another study [11] .…”

Section: Introductionmentioning

confidence: 93%

Outcomes of 2-octyl cyanoacrylate skin adhesives following musculoskeletal oncology surgery

et al. 2021

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2-octyl cyanoacrylate (2OCA) is a high-viscosity medical-grade tissue adhesive that is routinely used. However, no studies have evaluated its use in musculoskeletal surgery. We enrolled 99 patients who underwent musculoskeletal surgery. 2OCA was chosen for wound closure and was performed by a specific surgeon for all patients. The drying times for the adhesive were recorded, and photographs were obtained intra-operatively. Posttreatment follow-up consisted of queries regarding pain level and recording incisional dehiscence, wound infection, hematoma, and incisional bleeding. Data collection was performed postoperatively at 48 hours, 5 to 10 days, 14 days, and 30 days. Other adverse events were documented. 2OCA was applied to 110 incisions in 99 patients, comprising 62 female and 37 male patients. The mean age of patients was 50.41 (±16.83) years; mean incision length was 10.24 (±5.7) cm, and the mean pain score using a visual analogue scale was 2.37 on a postoperative day 7. The mean drying time was 1.81 (±0.59) minutes; 91 (91%) patients reported excellent and superior satisfaction, and the remaining patients reported “good” (6%) and “fair” (2%) satisfaction. The percentages of dehiscence, hematoma and keloid formation were considerably low. In this study, 2OCA was safe for musculoskeletal oncology surgical incisions. The incidence of postoperative adverse events was low. However, some patients develop hematomas. Postoperative pain was low, and patient satisfaction was high. 2OCA can be a practical alternative to traditional suture closure for skin incisions after musculoskeletal surgery.

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Comparison of skin closure techniques in patients undergoing open pancreaticoduodenectomy: A single center experience

Cited by 6 publications

References 21 publications

Preoperative Nomogram Predicts Non-home Discharge in Patients Undergoing Pancreatoduodenectomy

Preoperative Nomogram Predicts Non-home Discharge in Patients Undergoing Pancreatoduodenectomy

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

Outcomes of 2-octyl cyanoacrylate skin adhesives following musculoskeletal oncology surgery

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