Abstract
BackgroundSurgical site infections are the third most frequent type of nosocomial infections. Evidence-based recommendations have been given regarding preoperative hospitalization, hygiene and air-conditioning, patient conditions, and wound dressing. However, no general recommendations concerning wound closure exist. Systematic reviews and meta-analyses suppose a benefit of intracutaneous suture compared to skin staples in orthopedic and obstetric surgery. Literature data for skin closure in elective abdominal surgery are still deficient.Methods/DesignPatients scheduled for any elective abdominal surgery requiring midline or horizontal laparotomy are potentially eligible for the trial. Trial-specific exclusion criteria are date of admission exceeding four days prior to surgery, antibiotic treatment within the past 14 days, any previous midline or horizontal laparotomy in case the procedure requires the same skin incision as before, neurophysiological deficits or severe psychiatric or neurologic diseases that do not allow an informed consent or compliance, and participation in any other interventional trial with interference of intervention and outcome. The trial is created for process innovation within standardized surgical procedures. It is designed as a prospective randomized controlled single center trial in a parallel design including an active comparator and an intervention group. The intervention addresses the closure of skin after the main surgical procedure: intracutaneous suture in the intervention group and transcutaneous skin stapling in the control group. The rate of superficial surgical site infections is defined as the primary endpoint. Secondary endpoints are time for skin closure, satisfaction with the cosmetic outcome 30 days after surgery, prolongation of hospital stay, and duration of sick-leave due to surgical site infections. The primary efficacy analysis follows the intention-to-treat principle. A χ2 test will be applied.DiscussionThe trial is expected to balance the shortcomings of the current evidence. It will help to define the gold standard for wound closure in elective abdominal surgery. Patients’ safety and quality of life are assumed to be enhanced. Therapy costs are likely to be reduced and health care optimized.Trial registrationGerman Clinical Trials Register (DRKS) DRKS00004542.
Highlights
Surgical site infections are the third most frequent type of nosocomial infections
It will help to define the gold standard for wound closure in elective abdominal surgery
Superficial surgical site infection is defined as a category A1 infection according to the Center of Disease Control (CDC), as infection of the incision within 30 days after surgery, involving skin and subcutaneous tissue only and meeting one of the following criteria/clinical signs: (I) purulent secretion, cultural proof of bacteria derived from the tissue covering the incision or any secretion from the incision; (II) pain or tenderness, swelling, redness, warmth; (III) opening of the wound by the treating surgeon; and (IV) diagnosis made by the treating medical doctor
Summary
Surgical site infections are the third most common type of nosocomial infections. National health surveillance systems give evidence-based recommendations for their prevention and treatment. Authors’ contributions DKB queried if intracutaneous wound closure in elective abdominal surgery may reduce the incidence of superficial surgical site infections. He reviewed the trial protocol and contributed substantially to the trial concept. KM and LM conducted a systematic Pubmed literature research on the current evidence and generated the hypothesis They did a retrospective analysis on in-house data to prepare the calculation of sample size and power. They worked out a trial concept and created a study protocol.
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