Factors predicting stomal wound closure infection rates
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ORIGINAL ARTICLE
Factors predicting stomal wound closure infection rates N. Mirbagheri • J. Dark • S. Skinner
Received: 2 February 2012 / Accepted: 19 September 2012 Ó Springer-Verlag Italia 2012
Abstract Background Stoma closure is associated with high wound infection rates. The aim of this study was to evaluate risk factors for infection rates in such wounds, with particular emphasis on assessing the importance of the stomal wound closure technique. Methods A retrospective analysis of 142 patients who had undergone ileostomy or colostomy closure between 2002 and 2011 was performed. Postoperative outcome as measured by wound infection rate was recorded. Three different closure techniques were identified: primary closure (PC), primary closure with Penrose drain (PCP) and purse-string circumferential wound approximation technique (PSC). Other factors such as age, sex, ASA score, type of prophylactic antibiotics used, diabetes, smoking and obesity were also analysed. All other techniques were excluded. Results Our series consisted of 142 stomal closures (90 ileostomy and 52 colostomy closures). The patients had a median age of 63.5 years with an interquartile range of 50.1–73.2 years. The overall wound infection rate was 10.7 %. PC, PCP and PSC were associated with wound infection rates of 17.9, 10.5 and 3.6 %, respectively. Compared to PSC, PC and PCP were associated with
N. Mirbagheri S. Skinner Department of Surgery, Frankston Hospital, Hastings Road, Frankston, VIC, Australia N. Mirbagheri (&) Academic Surgical Unit, Dandenong Hospital, P.O. Box 478, Dandenong, VIC 3175, Australia e-mail: [email protected] J. Dark Department of Finance, University of Melbourne, Melbourne, VIC, Australia
significantly higher wound infection rates (p = 0.027 and p = 0.068, respectively). Obesity was a significant risk factor for wound infection (p = 0.024). Use of triple-agent antibiotics prophylactically had a protective effect on the infection rate (p = 0.012). Conclusions To reduce stomal wound closure infection rates, we recommend institution of closure techniques other than PC with or without a drain. Risk factors such as obesity should be addressed, and prophylactic triple antibiotics should be administered. Keywords Stoma Surgical site wound infection Surgical technique
Introduction Loop ileostomies are now commonly created as part of sphincter-saving low rectal cancer surgery in order to reduce morbidity associated with pelvic anastomotic leakage [1, 2]. Similarly, end colostomies are still created as part of Hartmann’s procedure for complicated diverticular disease, particularly in high-risk patients [3, 4]. The creation of such stomas is meant to have a protective effect in situations where distal anastomoses are precarious. However, stomal closures can be associated with significant morbidity, the most common of which is wound infection, a testament to the contaminated nature of this procedure. Given the elective nature of stoma closures in patients who may be otherwise well and the fact
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