Document Detail


Skin closure after trauma laparotomy in high-risk patients: opening opportunities for improvement.
MedLine Citation:
PMID:  23354235     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although many surgeons leave laparotomy incisions open after colon injury to prevent surgical site infection (SSI), other injured patient subsets are also at risk. We hypothesized that leaving trauma laparotomy skin incisions open in high-risk patients with any enteric injury or requiring damage control laparotomy (DCL) would not affect superficial SSI and fascial dehiscence rates.
METHODS: Patients who underwent trauma laparotomy (2004-2008) at two Level I centers were reviewed. To ensure a high-risk sample, only patients with transmural enteric injuries or need for DCL surviving 5 days or more were included. SSIs were categorized by the CDC (Centers for Disease Control and Prevention) criteria and risk factors were analyzed by skin closure (open vs. any closure). Significant (p < 0.05) univariate variables were applied to two multivariate analyses examining superficial SSI and fascial dehiscence.
RESULTS: Of 1,501 patients who underwent laparotomy, 503 met inclusion criteria. Patients were young (median, 28.0 years; range, 22.0-40.0 years) with penetrating (74%) or enteric (80%) injuries, and DCL (36%) and SSI (44%; superficial, 25%; deep, 3%; organ/space, 25%) were common. While no difference in superficial SSI after loose (n = 136) or complete skin closure (n = 224) was detected (p = 0.64), superficial SSIs were less common with open skin incisions (9.8%), despite multiple risk factors, than with any skin closure (31.1%, p < 0.001). Predictors of superficial SSIs and fascial dehiscence were each evaluated with multiple-variable logistic regression analysis. After adjusting for multiple potential confounding variables, any skin closure increased the risk of superficial SSIs approximately nine times (odds ratio, 8.6; p < 0.001) and fascial dehiscence six times (odds ratio, 5.7; p = 0.013).
CONCLUSION: Management of skin incisions takes careful consideration like any other step of a laparotomy. Our results suggest that the decision to leave skin open is one simple method to improve outcomes in high-risk patients.
LEVEL OF EVIDENCE: Therapeutic study, level III.
Authors:
Mark J Seamon; Brian P Smith; Lisa Capano-Wehrle; Abdulla Fakhro; Nicole Fox; Michael Goldberg; Niels M Martin; Abhijit S Pathak; Steven E Ross
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-04-05     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  433-9; discussion 439-40     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma and Surgical Critical Care, Department of Surgery, Cooper University Hospital, Camden, New Jersey 08103, USA. seamon-mark@CooperHealth.edu
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MeSH Terms
Descriptor/Qualifier:
Abdominal Injuries / surgery
Adult
Female
Humans
Laparotomy / adverse effects,  methods*
Male
Retrospective Studies
Risk Factors
Surgical Wound Dehiscence / prevention & control
Surgical Wound Infection / prevention & control*
Young Adult
Comments/Corrections
Erratum In:
J Trauma Acute Care Surg. 2013 Jul;75(1):185

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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