Intraoperative techniques to prevent deep or organ-space surgical site infection after emergency surgery for perforation peritonitis: A prospective two-center observational study

Abstract text (incl. references and figure legends)

Introduction: The rate of surgical site infection (SSI) after surgery for secondary peritonitis is very high. However, international guideline recommendations for intraoperative procedures to prevent SSI are controversial with insufficient evidence. This study aimed to reveal the relationship between intraoperative procedures of emergency surgery for perforation peritonitis and deep or organ-space SSI.

Material & Methods: This prospective, two-center observational study included patients aged ≥ 20 years who underwent emergency surgery for perforation peritonitis between April 2017 and March 2020. We compared patients with deep or organ-space SSI (Group S) to patients without SSIs or with superficial SSIs (Group C). Thereafter, we evaluated the association between intraoperative technical variables and deep or organ-space SSI using a multivariate logistic regression model. All multivariate analyses were adjusted for potentially relevant risk factors (e.g., age, body mass index, diabetes, smoking habit, and National Nosocomial Infection Surveillance risk index).

Results: Of the 79 patients enrolled in this study, 15 were in Group S and 64 were in Group C. The use of a wound protector device was significantly associated with decreased odds of deep or organ-space SSI (adjusted odds ratios [AOR], 0.034; 95% confidence intervals [CI]: 0.0045–0.26, p = 0.001). A 1000 ml increase in intra-abdominal lavage with normal saline was significantly associated with increased odds of deep or organ-space SSI (AOR: 1.24, 95% CI: 1.01–1.54, p = 0.044).

Conclusions: Wound protector devices should be used in emergency surgery for perforation peritonitis. Intra-abdominal massive or excessive lavage with normal saline for peritonitis has unsatisfactory benefits and increases the incidence of deep or organ-space SSI. Achieving consensus on this issue through a future randomized controlled trial is necessary.

Reference: Surg Infect (Larchmt). 2012;13:257-65.

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