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The Benefits of a Wound Protector in Preventing Incisional Surgical Site Infection in Elective Open Digestive Surgery: A Large-Scale Cohort Study

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Abstract

Background

The objective of this study was to evaluate the benefits of wound protectors (WPs) in preventing incisional surgical site infection (I-SSI) in open elective digestive surgery using data from a large-scale, multi-institutional cohort study.

Methods

Patients who had elective digestive surgery for malignant neoplasms between November 2009 and February 2011 were included. The protective value of WPs against I-SSI was evaluated.

Results

A total of 3201 patients were analyzed. A WP was used in 1022 patients (32%). The incident rate of I-SSI (not including organ/space SSI) was 9%. In the univariate and the multivariate analyses for perioperative risk factors for I-SSI, the use of WP was an independent favorable factor that reduced the incidence of I-SSI (odds ratio 0.73, 95% confidence interval 0.55–0.98. P = 0.038). The subgroup forest plot analyses revealed that WP reduced the risk of I-SSI only in patients aged 74 years or younger, males, non-obese patients (body mass index <25 kg/m2), patients with an American Society of Anesthesiologists score of 1/2, patients with a previous history of laparotomy, non-smokers, and patients who underwent colon and rectum operations. In patients who underwent colorectal surgery, the postoperative hospital stay was significantly shorter in patients with WP than those without WP (median 13 vs. 15 days, P = 0.040). In terms of the depth of SSI, WP only prevented superficial I-SSI and did not reduce the incidence of deep I-SSI.

Conclusions

WP is a useful device for preventing superficial I-SSI in open elective digestive surgery.

Trial registration number

UMIN000004723.

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Abbreviations

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CT:

Computed tomography

CI:

Confidence interval

DI-SSI:

Deep incisional surgical site infection

HBP:

Hepato-biliary-pancreatic

I-SSI:

Incisional surgical site infection

OR:

Odds ratio

OS-SSI:

Organ/space surgical site infection

SI-SSI:

Superficial incisional surgical site infection

WP:

Wound protector

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Acknowledgements

In addition to the authors listed on the title page, the following investigators participated in this study: Akira Ishikawa, Department of Surgery, Chubu Rosai Hospital; Atsushi Akutagawa, and Hiroshi Kono, Nagoya Ekisaikai Hospital; Hideki Matsuba and Yutaro Asaba, Kumiai Kosei Hospital; Eiji Takeuchi, Japanese Red Cross Nagoya Daiichi Hospital; Hiroshi Hasegawa and Shunichiro Komatsu, Japanese Red Cross Nagoya Daini Hospital; Makoto Kato and Akiko Okajima, Kamiiida Daiichi General Hospital; Kiyoshi Suzumura, Shizuoka Saiseikai General Hospital; Hideo Yamamoto and Masato Momiyama, Tokai Hospital; Michio Kanai and Keiji Aizu, Kasugai Municipal Hospital; Satoaki Kamiya, Tsushima City Hospital; Yasushi Mokuno and Hideo Matsubara, Yachiyo Hospital; Hitoshi Kubota and Shusaku Ohira, Handa City Hospital; Takehito Kato, Hideki Yamada, and Taro Aoba, Toyohashi Municipal Hospital; Toshiyuki Arai and Hidenari Goto, Anjo Kosei Hospital; Yasuhiro Kurumiya and Yasuyuki Fukami, Toyota Kosei Hospital; Yuichiro Tojima, Yoko Tanimura, and Naoya Yamaguchi, Chukyo Hospital; and Yuji Kaneoka, Koji Shibata, Maki Sunagawa, and Yoshihiko Yonekawa, Ogaki Municipal Hospital.

Author information

Authors and Affiliations

  1. The Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466–8550, Japan

    Keita Itatsu, Yukihiro Yokoyama, Gen Sugawara & Masato Nagino

  2. Department of Surgery, Kamiiida Daiichi General Hospital, Nagoya, Japan

    Keita Itatsu

  3. Department of Surgery, Tsushima Municipal Hospital, Tsushima, Japan

    Satoaki Kamiya

  4. Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan

    Masaki Terasaki

  5. Department of Surgery, Kumiai Kosei Hospital, Takayama, Japan

    Atsushi Morioka

  6. Department of Surgery, Yachiyo Hospital, Anjo, Japan

    Shinsuke Iyomasa

  7. Department of Surgery, Yamashita Hospital, Ichinomiya, Japan

    Kazuhisa Shirai

  8. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan

    Masahiko Ando

Authors
  1. Keita Itatsu
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  2. Yukihiro Yokoyama
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  3. Gen Sugawara
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  4. Satoaki Kamiya
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  5. Masaki Terasaki
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  6. Atsushi Morioka
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  7. Shinsuke Iyomasa
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  8. Kazuhisa Shirai
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  9. Masahiko Ando
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  10. Masato Nagino
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Corresponding author

Correspondence to Masato Nagino.

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Conflicts of interest

From October 2009 to September 2013, Ethicon Japan KK paid Nagoya University Graduate School of Medicine through the endowed chair’s (The Division of Surgical Infection) employment of Keita Itatsu, Yukihiro Yokoyama, and Gen Sugawara. The other authors had no conflicts of interest.

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Itatsu, K., Yokoyama, Y., Sugawara, G. et al. The Benefits of a Wound Protector in Preventing Incisional Surgical Site Infection in Elective Open Digestive Surgery: A Large-Scale Cohort Study. World J Surg 41, 2715–2722 (2017). https://doi.org/10.1007/s00268-017-4082-8

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  • DOI: https://doi.org/10.1007/s00268-017-4082-8

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