Prone positioning reduces perineal infections when performing the miles procedure

Area of Science:

• Surgical Oncology
• Colorectal Surgery
• Patient Safety

Background:

• Abdominoperineal resection (APR) is a key treatment for rectal cancers near the anal verge.
• Patient positioning during the perineal phase of APR (lithotomy vs. prone) impacts surgical outcomes.
• This study investigates the influence of patient positioning on perineal wound complications.

Purpose of the Study:

• To evaluate the effect of patient positioning on perineal wound complications after APR.
• To compare infection and dehiscence rates between supine and prone positions during APR.

Main Methods:

• Retrospective review of 149 rectal cancer patients undergoing APR between 2004-2014.
• Patients were categorized into supine (n=91) or prone (n=58) positioning groups.
• Analysis of perineal wound infection and dehiscence rates based on documented operative positioning.

Main Results:

• Perineal wound infection occurred in 22% of supine patients vs. 3.4% of prone patients (P=0.002).
• Perineal wound dehiscence was higher in the supine group (14.3%) compared to the prone group (3.4%) (P=0.032).
• Multivariable analysis indicated a 9.2-fold increased odds of infection for supine positioning, adjusted for obesity and smoking.

Conclusions:

• The prone position for the perineal phase of APR is associated with significantly lower rates of wound infection and dehiscence.
• Repositioning to prone may improve surgical outcomes and patient recovery after APR.
• Optimizing patient positioning is crucial for minimizing complications in APR procedures.