Journal Review in Emergency General Surgery: Surgical Site Complications

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.8 • 1.4K Ratings

🗓️ 14 November 2022

⏱️ 25 minutes

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Summary

The dreaded Surgical Site Complications! Join Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross from our Emergency General Surgery Team as they discuss surgical site complications and prevention techniques.

Paper 1: Arnold et. al. (2019) Not a Routine Case, Why Expect the Routine Outcome? Quantifying the Infectious Burden of Emergency General Surgery Using the NSQIP. American Surgeon

- NSQIP database 2005-2016 (>800,000 patients) including open/laparoscopic cholecystectomies, ventral hernia repairs, and partial colectomies
- Comparing outcomes in emergent vs elective cases
- Primary outcome: aggregate of SSIs which includes wound disruption, superficial SSI, deep SSI, and organ space SSI
- Results:
-- ↑SSI in the emergency group (5.3% vs 3.6%)
-- When controlling for multiple variables, emergency surgery associated with more SSIs (OR 1.15).

Paper 2: Lakhani et. al. (2022) Prophylactic negative pressure wound dressings reduces wound complications following emergency laparotomies: A systematic review and meta-analysis. Surgery

- NPWD remove excess fluid from subcutaneous space, ↓ collections/contaminants, promote angiogenesis, fibroblast infiltration
- Literature review 2005-2022 (NPWD, laparotomy, SSI)
- 1199 patients included (566 NPWD, 633 standard dressings)
- Results:
-- NPWD ↓ wound infection (OR 0.43) and wound breakdown (OR 0.36)
-- No change in LOS, readmission

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Transcript

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0:00.0	general surgery. I think we can all relate to how much of an issue this is in general surgery,
0:04.8	and particularly in emergency general surgery. Although we often see it as a nuisance,
0:09.6	it's important to remember that there are some significant sequela to SSI's, like increased cost
0:15.5	and healing time, higher rate of facial dehiscence and hernia formation, and that's not to mention
0:21.2	worsened cosmeticis. Absolutely, and this all reminds me of course of a recent case that I had
0:28.0	that I'm sure will be all too familiar to a lot of people out there. So I was called to see
0:32.7	a man in his late 50s with several days of worsening abdominal pain and obstapation. He had a
0:38.0	white count over 20,000 and was tachycardic. After resuscitation and antibiotics, the CT showed
0:44.1	free air and a sigmoid mass. He had diffuse, feculant paratinitis and underwent a sub-total
0:49.7	collectumine and dialyostomy. Now we all know where this is going. My post-op day 5 is when it is
0:55.4	red, beefy, tender, hot, and I was able to express a moderate amount of pus. I opened the wound
1:01.5	drains a large amount of pure lip material revealing intact fascia underneath. Now here are the
1:06.9	questions I think we need to ask ourselves. Could we have predicted this and could we have done
1:11.0	anything to prevent it? Yeah, I think those are great questions and certainly we have to
1:16.8	put her both whenever a clinical problem like this presents itself. So to get a better understanding
1:22.3	of the state of the evidence for surgical site infections and emergency general surgery, we
1:26.7	selected two related studies to look in more detail at in our podcast today.
1:32.5	So the articles we're going to be talking about today are number one, not a routine case,
1:37.8	why expect the routine outcome, quantifying the infectious burden of emergency general surgery
1:43.2	using NISQUIP. Arnold, at all, American Surgeon 2019 and number two, prophylactic negative
1:51.3	pressure wound dressings reduces wound complications following emergency laparotomies,
1:56.1	a systematic review and meta-analysis by Lacani, at all, in surgery 2022.
	...

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