Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples

Tomita, Koichi; Chiba, Naokazu; Ochiai, Shigeto; Yokozuka, Kei; Gunji, Takahiro; Hikita, Kosuke; Ozawa, Yosuke; Okihara, Masaaki; Sano, Tsuyoshi; Tsutsui, Rina; Shimazu, Motohide; Kawa, Shigeyuki

doi:10.1007/s11605-018-3754-5

Cited by 18 publications

(12 citation statements)

References 33 publications

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“…Current specialty guidelines call for skin closure after implantation to be done with either subcuticular suture or staples as the existing evidence does not clearly support either method as superior [8,9]. Data from other specialties have been published to look for differences in cosmesis, surgical site infection, and patient satisfaction between the two closure methods [10][11][12][13][14][15]. When these reviews are taken in sum, there is much conflicting data and no clear evidence as to the best technique.…”

Section: Introductionmentioning

confidence: 99%

Skin Closure Technique and Postprocedural Pain after Spinal Cord Stimulator Implantation: A Retrospective Review

D’Souza

North

Pittelkow

et al. 2021

Pain Research and Management

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Spinal cord and dorsal root ganglion stimulation are minimally invasive surgical techniques used to treat an array of chronic pain disorders. There is a paucity of data related to defining best practices in these specific patient populations, and historically, providers have relied on consensus committees to opine on the best techniques for patient safety and experience. The most efficacious mechanism of surgical closure—specifically a running suture closure compared to a surgical staple closure—is debated. A retrospective review of 155 patients implanted with either a spinal cord or dorsal root ganglion stimulator between 2017 and 2019 was undertaken to determine if the type of surgical closure was related to degree of postoperative surgical site discomfort. The primary outcome showed no statistically significant difference on postoperative pain scores between the suture (6.0 (IQR 5.0–8.0)) and staple (7.0 (IQR 5.0–8.0)) cohorts at postoperative day (POD) #1 (adjusted β 0.17 (95% CI −0.61 to 0.95), P = 0.670 ). This finding held for postoperative pain scores at POD #10 as well (staples (1.0 (IQR 0.0–4.0)) and suture (2.0 (IQR 0.0–5.0), adjusted β −0.39 (95% CI −1.35 to 0.58), P = 0.432 )). A regression analysis was performed to identify secondary factors impacting postoperative pain scores. Higher preoperative pain score (β 0.50 (95% CI 0.09 to 0.92), P = 0.019 ) and female gender (β 1.09 (95% CI 0.15 to 2.02), P = 0.023 ) were predictive of higher incisional pain scores at POD#10. Increasing age was associated with decreased incisional pain scores at POD#10 (β −0.06 (95% CI −0.09 to −0.03), P < 0.001 ). These findings are of interest to the pain practitioner and may be valuable in preoperative discussions with prospective patients.

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Section: Introductionmentioning

confidence: 99%

Skin Closure Technique and Postprocedural Pain after Spinal Cord Stimulator Implantation: A Retrospective Review

D’Souza

North

Pittelkow

et al. 2021

Pain Research and Management

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“…either internal biliary prostheses or external-internal biliary drainage). All these variables had been already proven to be independent risk factors for si-SSI elsewhere in the literature (12,13). Randomisation was performed by an external statistician using an online randomisation software.…”

Section: Randomisation and Maskingmentioning

confidence: 99%

Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial)

Aguirre–Allende

Alkorta-Zuloaga

Iglesias-Gaspar

et al. 2022

Preprint

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Background: subcuticular suture has proven to reduce superficial incisional SSI (si-SSI) in clean surgery. However, question remains regarding clean-contaminated procedures. The aim of this study is to assess that subcuticular suture is superior to staples in reducing si-SSI incidence in elective HBP surgery. Methods: single-centre, open-label, parallel, pragmatic randomized clinical trial conducted at a referral tertiary Hospital between January 2020 and April 2022. Patients eligible for elective HBP surgery were randomly assigned (1:1) to subcuticular suture or surgical staples wound closure using a minimisation method based on previously confirmed risk factors. The primary endpoint was the incidence of si-SSI. Considered secondary endpoints were major postoperative morbidity in both groups, additional wound complications, median hospital length of stay and need for re-hospitalisation. Results: Of the 379 patients, 346 patients were randomly assigned to receive skin closure with staples (n= 173) or subcuticular suture (n= 173). After exclusion of 11 participants, 167 and 168 patients respectively in the control and the experimental group received their allocated intervention. For the primary endpoint, no significant differences in si-SSI rate were found: 17 (9.82%) staples group vs. 8 (4.62%) in subcuticular suture group (p= 0.062). Subset analysis confirmed absence of significant differences. As for secondary endpoints, overall wound complications did not differ significantly between two procedures: 19 (10.98%) vs. 10 (6.35%) (p= 0.127). There were no treatment related adverse events. However, occurrence of si-SSI contributed to major postoperative morbidity in both groups (p< 0.001 and p= 0.018) and to a substantially prolonged postoperative hospitalization (p= 0.015). Conclusions: subcuticular suture might offer a relative benefit for skin closure reducing incidence of si-SSI after elective HBP surgery, although this was found not to be clinically relevant. Yet, this should not be interpreted as equivalence among both treatments. Therefore, wound closure strategy should not be based only on these grounds. Trial registration number: ISRCTN Registry number ISRCTN37315612 (registration date: 14/01/2020)

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“…Hasta la fecha, no se ha llevado a cabo ningú n estudio de este tipo que analizara la relació n entre la ISQ y la concentració n sé rica de vitamina D en cirugía hepatobiliopancreá tica, encontrá ndose nuestra població n a estudio en niveles similares a lo publicado anteriormente 9,25,26,29 verificá ndose la desnutrició n proteica y la prolongació n del tiempo quirú rgico como principales factores de riesgo 6 .…”

Section: Discusió Nunclassified

Infección del sitio quirúrgico en cirugía hepatobiliopancreática y su relación con la concentración sérica de vitamina D

et al. 2020

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c i r e s p . 2 0 2 0 ; x x ( x x ) : x x x -x x x informació n del artículo Historia del artículo: Recibido el 31 de octubre de 2019 Aceptado el 9 de marzo de 2020 On-line el xxx Palabras clave: Cirugía hepatobiliopancreá tica Infecció n nosocomial Infecció n del sitio quirú rgico Vitamina D r e s u m e nIntroduccio´n: La relació n entre las infecciones nosocomiales en pacientes quirú rgicos y la vitamina D ha sido estudiada por algunos autores. Sin embargo, hasta la fecha no existe ningú n estudio realizado sobre pacientes de cirugía hepatobiliar. El objetivo de nuestro trabajo es estudiar la infecció n del sitio quirú rgico (ISQ) en la unidad de cirugía hepatobiliar, y valorar su relació n con la concentració n sé rica de vitamina D.Me´todos: Se llevó a cabo un estudio analítico observacional de pacientes sucesivos intervenidos en la unidad de cirugía hepatobiliar de nuestro centro durante un añ o. Se incluyeron las intervenciones relativas a enfermedad biliar, pancreá tica y hepá tica. Se determinaron los niveles de vitamina D al ingreso, así como las ISQ de tipo superficial, profunda y ó rganocavitaria diagnosticadas durante el estudio. El seguimiento del paciente se realizó durante al menos un mes tras la cirugía, dependiendo de la enfermedad. La estadística se realizó mediante el programa estadístico R v.3.1.3.Resultados: La muestra quedó constituida por 321 pacientes, de los cuales el 25,8% presentó ISQ a expensas fundamentalmente de las infecciones ó rgano-cavitarias que presentaron una incidencia del 24,3%. Concentraciones sé ricas superiores a 33,5 nmol/l demostraron reducir en un 50% el riesgo de ISQ.Conclusiones: Las concentraciones elevadas de vitamina D en sangre demostraron ser un factor protector frente a las ISQ (OR: 0,99). Nuestros resultados sugieren una relació n directa entre la concentració n sé rica de vitamina D y la ISQ, justificando la realizació n de nuevos estudios prospectivos.

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Superficial Surgical Site Infection in Hepatobiliary-Pancreatic Surgery: Subcuticular Suture Versus Skin Staples

Abstract: Subcuticular suturing after hepatobiliary-pancreatic surgery was more efficacious in reducing postoperative superficial surgical site infection incidence than staples for skin closure.

Cited by 18 publications

References 33 publications

Skin Closure Technique and Postprocedural Pain after Spinal Cord Stimulator Implantation: A Retrospective Review

Skin Closure Technique and Postprocedural Pain after Spinal Cord Stimulator Implantation: A Retrospective Review

Subcuticular suture and incisional surgical-site infection in elective hepatobiliary and pancreatic surgery: an open-label, pragmatic randomized clinical trial (CLOSKIN trial)

Infección del sitio quirúrgico en cirugía hepatobiliopancreática y su relación con la concentración sérica de vitamina D

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