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Intraoperative techniques to prevent deep incisional or organ-space surgical site infection after emergency surgery for nonappendiceal perforation peritonitis: a prospective two-center observational study

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Abstract

Purpose

The rate of surgical site infection (SSI) after surgery for secondary peritonitis is very high. This study investigated the relationship between intraoperative procedures of emergency surgery for nonappendiceal perforation peritonitis and deep incisional or organ-space SSI.

Methods

This prospective, two-center observational study included patients aged ≥ 20 years who underwent emergency surgery for perforation peritonitis between April 2017 and March 2020. We compared patients with deep incisional or organ-space SSI (Group S) to patients without SSIs or with superficial incisional SSIs (Group C). Thereafter, we evaluated the association between intraoperative technical variables and deep incisional or organ-space SSI using a multivariate logistic regression model. All multivariate analyses were adjusted for potentially relevant risk factors (e.g., age, body mass index, diabetes, smoking habit, and National Nosocomial Infection Surveillance risk index).

Results

Of the 75 participants, 14 were in Group S and 61 were in Group C. The use of a wound protector device was significantly associated with decreased odds of deep incisional or organ-space SSI (adjusted odds ratios [AOR], 0.017; 95% confidence intervals [CI] 0.0014–0.19, p = 0.0011). A 1000 ml increase in intra-abdominal lavage with normal saline was significantly associated with increased odds of deep incisional or organ-space SSI (AOR: 1.28, 95% CI 1.02–1.61, p = 0.033).

Conclusion

Wound protector devices should be used in emergency surgery for nonappendiceal perforation peritonitis. Excessive intra-abdominal lavage with normal saline for peritonitis may have unsatisfactory benefits and increases the incidence of deep incisional or organ-space SSI.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors are grateful to Kyohei Miyamoto for providing their statistical expertise and Editage (http://www.editage.com) for the English language editing.

Funding

No sources of funding are declared.

Author information

Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan

    Yuko Okishio, Kentaro Ueda, Toru Nasu, Shuji Kawashima, Kosei Kunitatsu & Seiya Kato

  2. Department of Emergency Medicine, Katsuragi Hospital, Kishiwada, Japan

    Toru Nasu

  3. Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Mitsuru Masuda, Masato Ichimiya & Shiro Uyama

Authors
  1. Yuko Okishio
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  2. Kentaro Ueda
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Contributions

YO contributed to the study design and drafted the article. All authors contributed to the acquisition and analysis of the data. YO, KU, TN, SKw, and KK contributed to the data interpretation. MM, MI, SU, and SKt contributed to reviewing, editing, and supervision. All the authors participated in revising the article and have read, approved the final version of manuscript.

Corresponding author

Correspondence to Yuko Okishio.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was conducted according to the principles of the Declaration of Helsinki. The study protocol was approved by the Research Ethics Committee of the Wakayama Medical University Hospital and the Research Ethics Committee of the Japanese Red Cross Wakayama Medical Center. The Research Ethics Committee of the Wakayama Medical University Hospital and the Research Ethics Committee of the Japanese Red Cross Wakayama Medical Center waived the need for documentation of informed consent due to the prospective but non-randomized and observational nature of the study; The Research Ethics Committee of the Wakayama Medical University Hospital and the Research Ethics Committee of the Japanese Red Cross Wakayama Medical Center approved verval informed consent procedure.

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Okishio, Y., Ueda, K., Nasu, T. et al. Intraoperative techniques to prevent deep incisional or organ-space surgical site infection after emergency surgery for nonappendiceal perforation peritonitis: a prospective two-center observational study. Eur J Trauma Emerg Surg 49, 2215–2224 (2023). https://doi.org/10.1007/s00068-023-02301-0

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