Preventing surgical site infection after colorectal surgery: Delphi Consensus
USA: A recent study published in the Journal of the American College of Surgeons reports expert consensus on intraoperative technical/surgical aspects of surgical site infection (SSI) prevention by the surgical team during colorectal surgery (CRS).
The consensus was developed using a modified Delphi process and included a panel of 15 colorectal surgeons. Information from a targeted literature review and expert opinion was used. The consensus was developed with up to three rounds per topic, with a prespecified threshold of ≥70% agreement.
In 3 Delphi rounds, the 15 panelists achieved consensus on 16 evidence-based statements.
Incision location
Statement 1: There is insufficient evidence that off-midline incisions reduce the risk of SSI compared with midline incisions. However, off-midline incisions (when possible/appropriate) are associated with a reduced incisional hernia risk after (laparoscopic) colorectal surgery.
Wound protectors/retractors
Statement 2: Wound protectors/retractors are associated with reduced SSI risk when compared with no wound protectors/retractors.
Incise/adhesive drapes
Statement 3: There is insufficient evidence to support the role of incise/adhesive drapes to reduce the risk of SSI.
Wound irrigation
Statement 4.1: Antibiotic incisional wound irrigation should not be used for reducing SSI risk.
Statement 4.2: Wound irrigation with aqueous iodine is associated with reduced SSI risk when compared with no irrigation in high-risk, contaminated wounds.
Sterile incision closure tray
Statement 5: Use of a separate, dedicated sterile incision closure tray may be useful in reducing SSI risk when compared with no sterile incision closure trays.
Preclosure glove change
Statement 6: Preclosure glove changes may be useful in reducing SSI risk when compared with no glove changes.
Small bites compared with large bites in musculo-fascial closure
Statement 7: There is insufficient evidence that a small bite suture technique reduces SSI risk compared with a large bite suture technique. However, the small bite suture technique is associated with reduced incisional hernia risk.
Antimicrobial sutures
Statement 8: Triclosan-coated or impregnated antimicrobial sutures (TCS) are associated with a reduced risk of SSI compared with non-antimicrobial sutures.
Continuous compared with interrupted sutures
Statement 9: There is insufficient evidence to make a recommendation on the use of continuous or interrupted sutures on the impact of postoperative wound complications (SSI, incisional hernia, or wound dehiscence).
Sutures compared with staples
Statement 10: There is insufficient evidence to recommend the use of staples or subcuticular sutures for skin closure to reduce SSIs.
Topical skin adhesives
Statement 11: There is insufficient evidence to support the use of topical skin adhesives for superficial closure in reducing SSI.
Negative pressure wound therapy
Statement 12: Closed-incision negative pressure wound therapy (NPWT) may be useful in reducing SSI risk when compared with no NPWT in open, high-risk, contaminated surgery.
Advanced dressings
Statement 13: There is insufficient evidence to support the use of advanced dressings (for example silver dressings) as opposed to conventional dressings (such as standard gauze) to reduce the risk of SSI.
Delayed incision closure
Statement 14: There is insufficient evidence to make a recommendation on the use of delayed incisional closure after open CRS.
Subcutaneous drains
Statement 15: There is insufficient evidence to support the role of subcutaneous drains in reducing SSI risk.
"Using a modified Delphi method, a consensus has been achieved on a tailored set of recommendations on technical/surgical aspects that should be considered by surgical personnel during CRS to reduce the risk of SSI, particularly in areas where the evidence base is controversial or lacking," wrote the authors. "This document forms the basis for ongoing evidence for the topics discussed in this article or new topics based on newly emerging technologies in CRS."
Reference:
Ruiz-Tovar, Jaime MD, PhD; Boermeester, Marja A MD, PhD; Bordeianou, Liliana MD, FACS, FASCRS; Chang, George J MD, MS, FACS, FASCRS, FSSO; Gorgun, Emre MD, FACS, FASCRS; Justinger, Christoph MD; Lawson, Elise H MD, MSHS, FACS; Leaper, David J DSC, MD, CHM, FRCS, FACS, FL; Mahmoud, Najjia N MD, FACS, FASCRS; Mantyh, Christopher MD, FACS, FASCRS; McGee, Michael F MD, FACS, FASCRS; Nfonsam, Valentine MD, MS, FACS, FASCRS; Rubio-Perez, Ines MD, PhD; Wick, Elizabeth C. MD, FACS; Hedrick, Traci L MD, MS, FACS, FACRS Delphi Consensus on Intraoperative Technical/Surgical Aspects to Prevent Surgical Site Infection after Colorectal Surgery, Journal of the American College of Surgeons: January 2022 - Volume 234 - Issue 1 - p 1-11 doi: 10.1097/XCS.0000000000000022
