Abstract
Introduction
We have previously demonstrated that the risk of incisional surgical site infection (SSI) increases with obesity and that the most useful predictor of incisional SSI is the thickness of subcutaneous fat. Based on this finding, we have recently attempted a closure technique in surgery for the obese in which a subcutaneous drain is inserted for the prevention of incisional SSI. The aim of this study was to assess the utility of a subcutaneous drain for preventing incisional SSI in patients undergoing colorectal surgery who are at high risk for incisional SSI.
Materials and methods
Seventy-nine patients who underwent colorectal resection with high risk for incisional SSI, including patients with obesity (thick subcutaneous fat tissue, >20 mm) and those undergoing emergency operations, were enrolled in this study. The clinical features of these cases with or without a subcutaneous drain were reviewed, and statistical analysis was performed.
Results
In these high-risk cases, the overall incidence of incisional SSI was 27.8%. The incidences of incisional SSI in these cases with or without a subcutaneous drain were 14.3% and 38.6%, respectively. Our results suggest that subcutaneous drains are effective for preventing incisional SSI in patients with thick subcutaneous fat in colorectal surgery.
Conclusion
Therefore, incisional SSI surveillance for obese patients should be performed separately, which should lead to a further reduction in incisional SSIs.
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References
Konishi T, Watanabe T, Kishimoto J et al (2006) Elective colon and rectal surgery differ in risk factors for wound infection; result of prospective surveillance. Ann Surg 244:758–763
Bullard KM, Trudel JL, Baxter NN et al (2005) Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum 48:438–443
Clarke JS, Condon RE, Bartlett JG et al (1977) Preoperative oral antibiotics reduce septic complications of colon operations: results of prospective, randomized, double-blind clinical study. Ann Surg 186:251–259
Coppa GF, Eng K, Gouge TH et al (1983) Parenteral and oral antibiotics in elective colon and rectal surgery: a prospective, randomized trial. Am J Surg 145:62–65
Stone HH, Hooper CA, Kolb LD et al (1976) Antibiotic prophylaxis in gastric, biliary and colonic surgery. Ann Surg 184:443–452
Smith RL, Bohl JK, McElearney ST et al (2004) Wound infection after elective colorectal resection. Ann Surg 239:599–605
Dindo D, Muller MK, Weber M et al (2003) Obesity in general elective surgery. Lancet 361:2032–2035
Gendall KA, Raniga S, Kennedy R et al (2007) The impact of obesity on outcome after major colorectal surgery. Dis Colon Rectum 50:2223–2237
Malone DL, Genuit T, Tracy JK et al (2002) Surgical site infections: reanalysis of risk factors. J Surg Res 103:89–95
Chong TW, Sawyer RG (2002) Update on the epidemiology and prevention of surgical site infections. Curr Infect Dis Rep 4:484–490
Prentice AM (2006) The emerging epidemic of obesity in developing countries. Int J Epidemiol 35:93–99
Bellanger TM, Bray GA (2005) Obesity-related morbidity and mortality. J La State Med Soc 157(Spec No 1):S42–S49
Fujii T, Tsutsumi S, Matsumoto A et al (2010) Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT. Dig Surg 27:331–335
Allaire AD, Fisch J, McMahon MJ (2000) Subcutaneous drain vs. suture in obese women undergoing cesarean delivery. A prospective, randomized trial. J Reprod Med 45:327–331
Chowdri NA, Qadri SA, Parray FQ et al (2007) Role of subcutaneous drains in obese patients undergoing elective cholecystectomy: a cohort study. Int J Surg 5:404–407
Magann EF, Chauhan SP, Rodts-Palenik S et al (2002) Subcutaneous stitch closure versus subcutaneous drain to prevent wound disruption after cesarean delivery: a randomized clinical trial. Am J Obested Gynecol 186:1119–1123
Baier PK, Gluck NC, Baumgartner U et al (2010) Subcutaneous Redon drains do not reduce the incidence of surgical site infections after laparotomy. A randomized controlled trial on 200 patients. Int J Colorectal Dis 25:639–643
Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitations of nosocomial surgical site infections. Infect Control Hosp Epidemiol 13:606–608
Forse RA, Karam B, MacLean LD et al (1989) Antibiotic prophylaxis for surgery in morbidly obese patients. Surgery 106:750–756
Flancbaum L, Choban PS (1998) Surgical implications of obesity. Ann Rev Med 29:215–234
Roberts JV, Bates T (1992) The use of the body mass index in studies of abdominal wound infection. J Hosp Infect 20:217–220
Tokunaga M, Hiki N, Fukunaga T et al (2009) Effect of individual fat area on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg 96:496–500
Kanai H, Matsuzawa Y, Kotani K et al (1990) Close correlation of intra-abdominal fat accumulation to hypertension in obese women. Hypertension 16:484–490
Nystrom PO, Jonstam A, Hojer H et al (1987) Incisional infection after colorectal surgery in obese patients. Acta Chir Scand 153:225–227
Goodson WH, Hunt TK (1979) Deficient collagen formation by obese mice in a standard wound model. Am J Surg 138:692–694
Watanabe A, Kohnoe S, Shimabukuro R et al (2008) Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery. Surg Today 38:404–412
Acknowledgments
The authors would like to thank Saitoh Y, Yano T, Ohno M, Matsui Y, Muraoka S, and Sekiguchi M for their secretarial assistance.
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The authors declare that they have no competing financial interests.
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Fujii, T., Tabe, Y., Yajima, R. et al. Effects of subcutaneous drain for the prevention of incisional SSI in high-risk patients undergoing colorectal surgery. Int J Colorectal Dis 26, 1151–1155 (2011). https://doi.org/10.1007/s00384-011-1228-2
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DOI: https://doi.org/10.1007/s00384-011-1228-2