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    Factors predicting stomal wound closure infection rates

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    Author
    Mirbagheri, N; Dark, J; Skinner, S
    Date
    2013-04-01
    Source Title
    TECHNIQUES IN COLOPROCTOLOGY
    Publisher
    SPRINGER
    University of Melbourne Author/s
    Dark, Jonathan
    Affiliation
    Finance
    Metadata
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    Document Type
    Journal Article
    Citations
    Mirbagheri, N., Dark, J. & Skinner, S. (2013). Factors predicting stomal wound closure infection rates. TECHNIQUES IN COLOPROCTOLOGY, 17 (2), pp.215-220. https://doi.org/10.1007/s10151-012-0908-4.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/33096
    DOI
    10.1007/s10151-012-0908-4
    Description

    C1 - Journal Articles Refereed

    Abstract
    BACKGROUND: Stoma closure is associated with high wound infection rates. The aim of this study was to evaluate risk factors for infection rates in such wounds, with particular emphasis on assessing the importance of the stomal wound closure technique. METHODS: A retrospective analysis of 142 patients who had undergone ileostomy or colostomy closure between 2002 and 2011 was performed. Postoperative outcome as measured by wound infection rate was recorded. Three different closure techniques were identified: primary closure (PC), primary closure with penrose drain (PCP) and purse-string circumferential wound approximation technique (PSC). Other factors such as age, sex, ASA score, type of prophylactic antibiotics used, diabetes, smoking and obesity were also analysed. All other techniques were excluded. RESULTS: Our series consisted of 142 stomal closures (90 ileostomy and 52 colostomy closures). The patients had a median age of 63.5 years with an interquartile range of 50.1-73.2 years. The overall wound infection rate was 10.7%. PC, PCP and PSC were associated with wound infection rates of 17.9, 10.5 and 3.6%, respectively. Compared to PSC, PC and PCP were associated with significantly higher wound infection rates (p = 0.027 and p = 0.068, respectively). Obesity was a significant risk factor for wound infection (p = 0.024). Use of triple-agent antibiotics prophylactically had a protective effect on the infection rate (p = 0.012). CONCLUSIONS: To reduce stomal wound closure infection rates, we recommend institution of closure techniques other than PC with or without a drain. Risk factors such as obesity should be addressed, and prophylactic triple antibiotics should be administered.
    Keywords
    Surgery; Surgical Methods and Procedures

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