A. Acker1, J. Leonard1, M. J. Seamon1, D. N. Holena1, J. Pascual1, B. Smith1, P. M. Reilly1, N. D. Martin1 1University Of Pennsylvania,Surgery,Philadelphia, PA, USA
Introduction:
The incidence of surgical site infection (SSI) has become a key quality indicator following clean and clean/contaminated surgical procedures. In contrast, contaminated and dirty wounds have garnered little attention with this quality metric because of the expected higher complication incidence. We hypothesized that wound management strategies in this high risk population vary significantly and might not add value to the overall care.
Methods:
This is a retrospective, observational study of trauma patients who underwent an exploratory laparotomy at an urban, academic, level 1 trauma center from 2014-2016. Deaths prior to hospital discharge were excluded. Wounds were classified using the CDC definition on review of the operative reports. SSI was determined by review of the medical record, also per CDC definition. Wound management strategies were categorized as either primary skin closure or closure by secondary intention. Outcomes were compared using Chi square or Kruskal-Wallis test.
Results:
There were 128 patients that met study criteria. Fifty-five (42.9%) wounds were left open to close by secondary intention. In the wounds that were closed primarily (n=73), 8 (10.9%) developed a SSI; whereas 12 of 55 (21.8%) open wounds still developed an SSI. There were significant differences in the average LOS (24.7 vs 11.6 days, p=0.05), number of office visits (2.8 vs 1.8, p=0.04), and time from surgery to the last office visit (107 vs. 57, p= 0.03) between patients who were treated with secondary intention closure compared to those closed primarily who did not suffer SSI.
Conclusions:
There is significant incidence of SSI in contaminated and dirty traumatic abdominal wounds however, wound management strategies vary widely within this cohort. Closure by secondary intention, regardless of the presence of infection, requires significantly more resource utilization. Further research is needed to define the actual value of each wound management strategy weighed against the risk of SSI.