TY - JOUR
T1 - An international assessment of surgeon practices in abdominal wound closure and surgical site infection prevention by the European Society for Coloproctology
AU - Chowdhury, Sharfuddin
AU - El‐Hussuna, Alaa
AU - Gallo, Gaetano
AU - Keatley, James
AU - Kelly, Michael E.
AU - Minaya‐Bravo, Ana
AU - Ovington, Liza
AU - Pata, Francesco
AU - Pellino, Gianluca
AU - Pinkney, Thomas
AU - Sanchez Guillen, Luis
AU - Schmitz, Niels‐Derrek
AU - Spychaj, Kerstin
AU - Riess, Celine
AU - Ramshorst, Gabrielle H. van
N1 - © 2023 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland
PY - 2023/5
Y1 - 2023/5
N2 - Aim: The burden of abdominal wound failure can be profound. Recent clinical guidelines have highlighted the heterogeneity of laparotomy closure techniques. The aim of this study was to investigate current midline closure techniques and practices for prevention of surgical site infection (SSI). Method: An online survey was distributed in 2021 among the membership of the European Society of Coloproctology and its partner societies. Surgeons were asked to provide information on how they would close the abdominal wall in three specific clinical scenarios and on SSI prevention practices. Results: A total of 561 consultants and trainee surgeons participated in the survey, mainly from Europe (n = 375, 66.8%). Of these, 60.6% identified themselves as colorectal surgeons and 39.4% as general surgeons. The majority used polydioxanone for fascial closure, with small bite techniques predominating in clean-contaminated cases (74.5%, n = 418). No significant differences were found between consultants and trainee surgeons. For SSI prevention, more surgeons preferred the use of mechanical bowel preparation (MBP) alone over MBP and oral antibiotics combined. Most surgeons preferred 2% alcoholic chlorhexidine (68.4%) or aqueous povidone-iodine (61.1%) for skin preparation. The majority did not use triclosan-coated sutures (73.3%) or preoperative warming of the wound site (78.5%), irrespective of level of training or European/non-European practice. Conclusion: Abdominal wound closure technique and SSI prevention strategies vary widely between surgeons. There is little evidence of a risk-stratified approach to wound closure materials or techniques, with most surgeons using the same strategy for all patient scenarios. Harmonization of practice and the limitation of outlying techniques might result in better outcomes for patients and provide a stable platform for the introduction and evaluation of further potential improvements.
AB - Aim: The burden of abdominal wound failure can be profound. Recent clinical guidelines have highlighted the heterogeneity of laparotomy closure techniques. The aim of this study was to investigate current midline closure techniques and practices for prevention of surgical site infection (SSI). Method: An online survey was distributed in 2021 among the membership of the European Society of Coloproctology and its partner societies. Surgeons were asked to provide information on how they would close the abdominal wall in three specific clinical scenarios and on SSI prevention practices. Results: A total of 561 consultants and trainee surgeons participated in the survey, mainly from Europe (n = 375, 66.8%). Of these, 60.6% identified themselves as colorectal surgeons and 39.4% as general surgeons. The majority used polydioxanone for fascial closure, with small bite techniques predominating in clean-contaminated cases (74.5%, n = 418). No significant differences were found between consultants and trainee surgeons. For SSI prevention, more surgeons preferred the use of mechanical bowel preparation (MBP) alone over MBP and oral antibiotics combined. Most surgeons preferred 2% alcoholic chlorhexidine (68.4%) or aqueous povidone-iodine (61.1%) for skin preparation. The majority did not use triclosan-coated sutures (73.3%) or preoperative warming of the wound site (78.5%), irrespective of level of training or European/non-European practice. Conclusion: Abdominal wound closure technique and SSI prevention strategies vary widely between surgeons. There is little evidence of a risk-stratified approach to wound closure materials or techniques, with most surgeons using the same strategy for all patient scenarios. Harmonization of practice and the limitation of outlying techniques might result in better outcomes for patients and provide a stable platform for the introduction and evaluation of further potential improvements.
KW - Abdominal wound
KW - Abdominal wound dehiscence
KW - Colorectal, fascial closure
KW - Incisional hernia
KW - Surgical site infection
KW - Abdominal wound
KW - Abdominal wound dehiscence
KW - Colorectal
KW - Fascial closure
KW - Incisional hernia
KW - Surgical site infection
KW - Abdominal wound
KW - Abdominal wound dehiscence
KW - Colorectal
KW - Fascial closure
KW - Incisional hernia
KW - Surgical site infection
UR - https://doi.org/10.1111/codi.16500
U2 - 10.1111/codi.16500
DO - 10.1111/codi.16500
M3 - Article
C2 - 36747373
SN - 1462-8910
VL - 25
SP - 1014
EP - 1025
JO - Colorectal Disease
JF - Colorectal Disease
IS - 5
ER -