Reduction of wound infection in high-risk surgical patients

During a 9-year period, 183 consecutive patients underwent total colectomy and the endorectal ileal pull-through procedure (ERIPT) for ulcerative colitis (UC) (n = 156), familial polyposis (n = 25), or Hirschsprung's disease (n = 2). The average age was 29.4 years (range 7.1-59.1 years). All patients with UC were steroid-dependent at the time of operation. Two groups were retrospectively reviewed based on the management of their midline abdominal wounds. Ninety consecutive patients underwent the ERIPT procedure between 1983 and 1987 with stapled skin closure and perioperative intravenous antibiotics (group 1A). Between 1988 and 1992, 93 patients had abdominal wall closure in the same manner, however, the wounds were probed daily in four to six sites for the first five postoperative days with a Q-tip moistened with 2 per cent aqueous mercurachrome solution (group 2A). Approximately four months after ERIPT, ileostomy closure was performed on 176 of the patients, of whom 89 had no wound probing (group 1B), and 87 had probing (group 2B). Following colectomy and the ERIPT procedure, 22/90 group 1A patients (24.4%) and 4/93 group 2A patients (4.3%) developed wound infections. Following ileostomy closure only 3/89 (3.4%) group 1B patients and 1/87 (1.2%) group 2B patients developed wound infections. No group 2A or B patients required wound packing, and none had prolonged hospitalization. In contrast, 17 group 1A patients spent more than 1 extra day of hospitalization (mean 2.8 days) and required wound packing a mean of 22.6 days after hospital discharge. This wound infection rate is significantly lower for group 2A versus 1A patients (P < 0.0001, ANOVA).(ABSTRACT TRUNCATED AT 250 WORDS)