Prevalence and predictors of surgical site infections after bowel resection for Crohn’s disease: the role of dual-ring wound protector
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Surgical site infections (SSIs) have become a leading cause of preventable morbidity and mortality in surgery. The aim was to evaluate the efficacy of a dual-ring wound protector to prevent the SSIs in Crohn’s disease (CD) after bowel resection.
This retrospective observational study included all CD patients undergoing bowel resection at the Inflammatory Bowel Disease Center between January 2015 and June 2018 at Sir Run Run Shaw Hospital. Risk factors of SSIs were evaluated by assessing preoperative clinical characteristics and perioperative treatments in univariate and multivariate analyses. Outcomes for CD patients with and without the wound protector were compared.
Three hundred forty-four CD patients were enrolled in this study, 121 (35.2%) patients had postoperative complications, of whom, 72 (20.9%) patients developed SSIs (12.8% patients with incisional SSI and 8.1% patients with organ/space SSI). There was a significant reduction in the incidence of incisional SSI in the wound protector group (8.1% vs 16.8%, p < 0.05). No significant differences were identified in organ/space SSI between groups with and without wound protector (6.3% vs 9.8%, p = 0.232). Incisional SSI correlated with preoperative albumin, C-reactive protein, white blood cell, age (≤ 16), penetrating disease behavior, surgical history, open surgery, stoma creation, estimated blood loss, infliximab, and wound protector (p < 0.05). Multivariate analysis identified the wound protector to be one of independent factors for preventing incisional SSIs (OR 0.357, 95% CI 0.161–0.793, p < 0.05).
Among the CD patients with bowel resection, the use of a dual-ring wound protector during surgery significantly reduced the risk of incisional SSI.
KeywordsCrohn’s disease Surgical site infection Wound protector Bowel resection
The authors gratefully acknowledge all of the investigators for their contributions to the trial, as well as Bin Chen, who provided medical writing assistance.
Xiaolong Ge and Wei Zhou contributed to the study conception and design, Xiaolong Ge, Weilin Qi, and Shasha Tang contributed to the acquisition of data, Wei Liu and Jiemin Lv contributed to the analysis and interpretation of data, Xiaolong Ge and Shasha Tang contributed to the drafting of manuscript, and Qian Cao, Xiujun Cai, and Wei Zhou contributed to the critical revision.
Supported by grants from National Natural Science Foundation of China (81800474) and Zhejiang Natural Science Foundation (LY18H030006).
Compliance with ethical standards
The institutional review board of Sir Run Run Shaw Hospital approved the project.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 5.Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, Warusavitarne J, Buskens CJ, van Bodegraven AA, Brink MA, ECJ C, van Wagensveld BA, MCM R, Crolla R, Noomen CG, Houdijk APJ, Mallant RC, Boom M, Marsman WA, Stockmann HB, Mol B, de Groof AJ, Stokkers PC, D’Haens GRR, Bemelman WA, group LCs (2017) Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol 2(11):785–792. https://doi.org/10.1016/S2468-1253(17)30248-0 CrossRefGoogle Scholar
- 6.Fumery M, Seksik P, Auzolle C, Munoz-Bongrand N, Gornet JM, Boschetti G, Cotte E, Buisson A, Dubois A, Pariente B, Zerbib P, Chafai N, Stefanescu C, Panis Y, Marteau P, Pautrat K, Sabbagh C, Filippi J, Chevrier M, Houze P, Jouven X, Treton X, Allez M, investigators Rsg (2017) Postoperative complications after ileocecal resection in Crohn’s disease: a prospective study from the REMIND group. Am J Gastroenterol 112(2):337–345. https://doi.org/10.1038/ajg.2016.541 CrossRefGoogle Scholar
- 7.Zuo L, Li Y, Wang H, Zhu W, Zhang W, Gong J, Li N, Li J (2015) A practical predictive index for intra-abdominal septic complications after primary anastomosis for Crohn’s disease: change in C-reactive protein level before surgery. Dis Colon Rectum 58(8):775–781. https://doi.org/10.1097/DCR.0000000000000414 CrossRefGoogle Scholar
- 11.Bressan AK, Aubin JM, Martel G, Dixon E, Bathe OF, Sutherland FR, Balaa F, Mimeault R, Edwards JP, Grondin SC, Isherwood S, Lillemoe KD, Saeed S, Ball CG (2018) Efficacy of a dual-ring wound protector for prevention of surgical site infections after pancreaticoduodenectomy in patients with intrabiliary stents: a randomized clinical trial. Ann Surg 268(1):35–40. https://doi.org/10.1097/SLA.0000000000002614 CrossRefGoogle Scholar
- 12.Pinkney TD, Calvert M, Bartlett DC, Gheorghe A, Redman V, Dowswell G, Hawkins W, Mak T, Youssef H, Richardson C, Hornby S, Magill L, Haslop R, Wilson S, Morton D, West Midlands Research C, Investigators RT (2013) Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI trial). Bmj 347:f4305. https://doi.org/10.1136/bmj.f4305 CrossRefGoogle Scholar
- 14.Gheorghe A, Calvert M, Pinkney TD, Fletcher BR, Bartlett DC, Hawkins WJ, Mak T, Youssef H, Wilson S, West Midlands Research C, Group RTM (2012) Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery. Ann Surg 255(6):1017–1029. https://doi.org/10.1097/SLA.0b013e31823e7411 CrossRefGoogle Scholar
- 15.Luo Y, Qiu YE, Mu YF, Qin SL, Qi Y, Zhong M, Yu MH, Ma LY (2017) Plastic wound protectors decreased surgical site infections following laparoscopic-assisted colectomy for colorectal cancer: a retrospective cohort study. Medicine 96(37):e7752. https://doi.org/10.1097/MD.0000000000007752 CrossRefGoogle Scholar
- 16.Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, Abbas M, Atema JJ, Gans S, van Rijen M, Boermeester MA, Egger M, Kluytmans J, Pittet D, Solomkin JS, Group WHOGD (2016) New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 16(12):e276–e287. https://doi.org/10.1016/S1473-3099(16)30398-X CrossRefGoogle Scholar
- 17.Hedrick TL, Harrigan AM, Sawyer RG, Turrentine FE, Stukenborg GJ, Umapathi BA, Friel CM (2015) Defining surgical site infection in colorectal surgery: an objective analysis using serial photographic documentation. Dis Colon Rectum 58(11):1070–1077. https://doi.org/10.1097/DCR.0000000000000466 CrossRefGoogle Scholar
- 21.Maeda K, Nagahara H, Shibutani M, Otani H, Sakurai K, Toyokawa T, Tanaka H, Kubo N, Muguruma K, Kamata N, Yamagami H, Hirakawa K (2015) A preoperative low nutritional prognostic index correlates with the incidence of incisional surgical site infections after bowel resection in patients with Crohn’s disease. Surg Today 45(11):1366–1372. https://doi.org/10.1007/s00595-014-1044-8 CrossRefGoogle Scholar
- 23.Mohan HM, Mcdermott S, Fenelon L, Fearon NM, O’Connell PR, Oon SF, Burke J, Keane E, Shields C, Winter DC, Members of the University College Dublin Wound Retractor Study G (2012) Plastic wound retractors as bacteriological barriers in gastrointestinal surgery: a prospective multi-institutional trial. J Hosp Infect 81(2):109–113. https://doi.org/10.1016/j.jhin.2012.03.005 CrossRefGoogle Scholar
- 26.Uchino M, Ikeuchi H, Bando T, Chohno T, Sasaki H, Horio Y, Nakajima K, Takesue Y (2017) Efficacy of preoperative oral antibiotic prophylaxis for the prevention of surgical site infections in patients with Crohn disease: a randomized controlled trial. Ann Surg 269:420–426. https://doi.org/10.1097/SLA.0000000000002567 CrossRefGoogle Scholar
- 27.Uchino M, Ikeuchi H, Matsuoka H, Bando T, Ichiki K, Nakajima K, Tomita N, Takesue Y (2013) Risk factors for surgical site infection and association with infliximab administration during surgery for Crohn’s disease. Dis Colon Rectum 56(10):1156–1165. https://doi.org/10.1097/DCR.0b013e31829f682c CrossRefGoogle Scholar
- 28.Lightner AL, Mathis KL, Tse CS, Pemberton JH, Shen B, Kochlar G, Singh A, Dulai PS, Eisenstein S, Sandborn WJ, Parry L, Stringfield S, Hudesman D, Remzi F, Loftus EV Jr (2018) Postoperative outcomes in vedolizumab-treated patients undergoing major abdominal operations for inflammatory bowel disease: retrospective multicenter cohort study. Inflamm Bowel Dis 24(4):871–876. https://doi.org/10.1093/ibd/izx076 CrossRefGoogle Scholar
- 29.Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y, group Gc (2018) Anti-TNF therapy is associated with an increased risk of postoperative morbidity after surgery for ileocolonic Crohn disease: results of a prospective nationwide cohort. Ann Surg 267(2):221–228. https://doi.org/10.1097/SLA.0000000000002017 CrossRefGoogle Scholar
- 32.Ikeshima R, Mizushima T, Takahashi H, Haraguchi N, Nishimura J, Hata T, Matsuda C, Ikenaga M, Nakajima K, Yamamoto H, Murata K, Doki Y, Mori M (2018) The efficacy of active drainage for preventing postoperative organ/space surgical site infections in patients with Crohn’s disease. Surg Today 48(1):25–32. https://doi.org/10.1007/s00595-017-1549-z CrossRefGoogle Scholar
- 34.Levy SM, Holzmann-Pazgal G, Lally KP, Davis K, Kao LS, Tsao K (2013) Quality check of a quality measure: surgical wound classification discrepancies impact risk-stratified surgical site infection rates in pediatric appendicitis. J Am Coll Surg 217(6):969–973. https://doi.org/10.1016/j.jamcollsurg.2013.07.398 CrossRefGoogle Scholar