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Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery

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Abstract

Background

Surgical site infection (SSI) prevention bundles include the simultaneous use of different measures, which individually have demonstrated an effect on prevention of SSI. The implementation of bundles can yield superior results to the implementation of individual measures. The aim of this study was to address the effect of the application of a bundle including intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, on the surgical site infection after elective laparoscopic colorectal cancer surgery.

Methods

A prospective, randomized study was performed, including patients with diagnosis of colorectal neoplasms and plans to undergo an elective laparoscopic surgery. The patients were randomized into two groups: those patients following standard bundles (Group 1) and those ones following the experimental bundle with three additional measures, added to the standard bundle. Incisional and organ space SSI were investigated. The study was assessor-blinded.

Results

A total of 198 patients were included in the study, 99 in each group. The incisional SSI rate was 16% in Group 1 and 2% in Group 2 [p = 0.007; RR = 5.6; CI 95% (1.4–17.8)]. The organ–space SSI rate was 4% in Group 1 and 0% in Group 2 [p = 0.039; RR = 1.7; CI 95% (1.1–11.6)]. Median hospital stay was 5.5 days in Group 1 and 4 days in Group 2 (p = 0.028).

Conclusions

The addition of intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples, to a standard bundle of SSI prevention, reduces the incisional and organ–space SSI and consequently the hospital stay, after elective laparoscopic colorectal cancer surgery (ClinicalTrials.gov Identifier: NCT03081962).

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Authors and Affiliations

  1. Department of Surgery, Hospital Rey Juan Carlos, Madrid, Spain

    Jaime Ruiz-Tovar

  2. Department of Surgical Nursery, Garcilaso Clinic, Madrid, Spain

    Carolina Llavero

  3. Department of Surgery, University Hospital Ramon y Cajal, Madrid, Spain

    Vicente Morales

  4. Department of Pathology, Universidad Autónoma de Madrid, Madrid, Spain

    Carlos Gamallo

Authors
  1. Jaime Ruiz-Tovar
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  2. Carolina Llavero
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  3. Vicente Morales
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  4. Carlos Gamallo
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Correspondence to Jaime Ruiz-Tovar.

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Disclosure

Jaime Ruiz-Tovar, Carolina Llavero, Vicente Morales, and Carlos Gamallo, have no conflicts of interest or financial ties to disclose.

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Ruiz-Tovar, J., Llavero, C., Morales, V. et al. Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery. Surg Endosc 32, 3495–3501 (2018). https://doi.org/10.1007/s00464-018-6069-4

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  • DOI: https://doi.org/10.1007/s00464-018-6069-4

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