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To close or not to close? Wound management in emergent colorectal surgery, an EAST multicenter prospective cohort
Cristina B Feather1, Scott Rehrig, Rebecca Allen
1From the Anne Arundel Medical Center and Doctors Community Medical Center (C.B.F., S.R., R.A., J.R.K., J.T.), Luminis Health, Annapolis, Maryland; Cooper University Hospital (N.B., E.M.K.), Camden, New Jersey; Maine Medical Center (D.C.C., C.R.F.), Portland, Maine; Yale New Haven Hospital (B.B., A.A.M.), New Haven, Connecticut; Crozer Chester Medical Center (S.S., A.R.), Upland; Hospital of the University of Pennsylvania (G.A.B., J.L.P.), Philadelphia, Pennsylvania; University of Texas Southwestern Medical Center (D.B.), Dallas, Texas; Loma Linda University Medical Center (D.S., N.W.), Loma Linda, California; Jackson Memorial Hospital (J.L., B.N.), University of Miami, Miami, Florida; St. Mary's Medical Center (F.A., L.A.T.), Florida Atlantic University, West Palm Beach, Florida; University of California at Irvine Health (J.N., M.M.), Orange; Zuckerberg San Francisco General Hospital (R.T., S.B.K.), UCSF, San Francisco, California; Medical City Plano (M.C.), Envision Health, Plano, Texas; OhioHealth Grant Medical Center (M.K., K.S.), Columbus, Ohio; and Texas Tech University Health Science Center (A.P.S.), Lubbock, Texas.
Insights
Complete skin closure in emergent colorectal surgery is linked to lower mortality and infection rates compared to open or loosely closed wounds. This technique may improve patient outcomes and reduce hospital stays.
Area of Science:
- Colorectal Surgery
- Surgical Site Infection (SSI)
- Wound Management
Background:
- Emergent colorectal surgery presents challenges in wound management.
- Surgical site infections (SSI), hospital length of stay (LOS), and mortality are critical outcomes.
- The impact of different wound closure techniques on these outcomes requires investigation.
Purpose of the Study:
- To evaluate the clinical impact of wound management techniques on SSI, LOS, and mortality in emergent colorectal surgery.
- To compare outcomes between skin closed (SC), skin loosely closed (SLC), and skin open (SO) wound management strategies.
Main Methods:
- A prospective observational study included 557 patients undergoing urgent or emergent colorectal surgery across 15 institutions.
- Patients were categorized by wound closure: SC, SLC, or SO.
- Multivariable regression analysis adjusted for patient and procedural factors to assess outcomes.
Main Results:
- The skin closed (SC) group exhibited the lowest rates of SSI and mortality.
- Skin open (SO) closure was associated with increased mortality risk (OR, 3.003; p = 0.028) compared to SC.
- Skin loosely closed (SLC) was linked to a higher risk of superficial SSI (OR, 3.439; p = 0.014) compared to SC.
Conclusions:
- Complete skin closure (SC) may be a viable and beneficial wound management technique in emergent colorectal surgery.
- While SO is linked to mortality, SLC increases superficial SSI risk.
- Optimizing wound closure strategies can potentially improve patient outcomes.
Background:
This study aimed to determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS), and mortality in emergent colorectal surgery.
Methods:
A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS, and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, intensive care unit admission, vasopressor use, procedure details, and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates.
Results:
In total, 557 patients were included (SC, n = 262; SLC, n = 124; SO, n = 171). Statistically significant differences in body mass index, race/ethnicity, American Society of Anesthesiologist scores, EBL, intensive care unit admission, vasopressor therapy, procedure details, and wound class were observed across groups. Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group. After risk adjustment, SO was associated with increased risk of mortality (OR, 3.003; p = 0.028) in comparison with the SC group. Skin loosely closed was associated with increased risk of superficial SSI (OR, 3.439; p = 0.014), after risk adjustment.
Conclusion:
When compared with the SC group, the SO group was associated with mortality but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery.
Level Of Evidence:
Therapeutic/Care Management; Level III.
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