J. Kwok1, J. Cai1, C.A. Buck2, A.T. King2, M.R. Tokala2, K.L. Bower1, J.D. Stodghill1, B.R. Collier1, J.R. Gillen1 1Virginia Tech Carilion School of Medicine, Department Of Surgery, Roanoke, VIRGINIA, USA 2Carilion Clinic, Health Analytics Research, Roanoke, VIRGINIA, USA
Introduction: Abdominal fascial dehiscence (FD) is a postoperative complication with significant morbidity and mortality. The incidence of fascial dehiscence exceeded the national average at our institution. Since small bite fascial closure technique has been shown to decrease dehiscence rate compared to traditional 10 mm bites in elective low-risk populations. We hypothesized that a 5 mm small bite fascial closure technique would reduce the fascial dehiscence rate in patients undergoing both elective and emergent laparotomy at our institution.
Methods: Patients undergoing an operation requiring a midline laparotomy were identified. Cohort time periods were defined as Pre-intervention (6/1/2019 – 5/31/2021) and Post-intervention (4/1/22 – 6/30/23). Intervention consisted of simulation lab education and training for surgical residents and faculty regarding small bite fascial closure technique. Demographics and outcomes were compared. Primary outcome was fascial dehiscence as identified by PSI-14 or ICD-10 code and confirmed via chart review. Statistical comparisons were performed using either Kruskal-Wallis ANOVA or Fisher’s exact test (p<0.05).
Results: There were 1611 patients in the pre-intervention cohort and 906 patients in the post-intervention cohort. Demographics and outcomes were similar between the two cohorts. Average BMI was 29 in both groups. The dehiscence rate significantly decreased from pre-intervention to post-intervention based on both ICD-10 (2.05% vs. 0.88%, p = 0.029) and PSI-14 definitions (0.99% vs. 0.22%, p = 0.028).
Conclusion: This study demonstrated that the small bite fascial closure technique significantly decreased the rate of fascial dehiscence in patients undergoing laparotomy at our institution in an overweight patient population. This technique offers a teachable and low-cost method to mitigate this complication.