Reduction of surgical site infections by use of pulsatile lavage irrigation after prolonged intra-abdominal surgical procedures.
BACKGROUND
Surgical site infections cause significant postoperative morbidity and may be reduced by pressurized irrigation of high-risk laparotomy wounds before closure. This was a retrospective review (June 2007 to May 2008) from a surgical unit at a tertiary care center.


METHODS
Patients undergoing laparotomy extending beyond 4 hours, when a standard wound management strategy was instituted by either simple irrigation or pressurized pulsatile lavage (<15 psi) with saline before closure, were included. The outcome measures were the surgical site infections and factors contributing to them.


RESULTS
The median surgical time for the patients was 8 hours, with 34 wounds managed by simple irrigation and 42 wounds managed by pulse irrigation. Both groups had similar characteristics. Overall there were 15 (20%) surgical site infections. Significantly fewer infections occurred in the pulse irrigation group (10% vs 32%; P = .019). The use of a pulse irrigation device was the only factor associated with a reduction in wound infections (P = .019).


CONCLUSIONS
Surgical site infections appear to be reduced with pulsatile lavage irrigation of wounds before skin closure in patients undergoing prolonged intra-abdominal surgeries.
Section of Surgical Oncology, Department of Surgery, Milton S Hershey Medical Center, Hershey, PA 17033-0850, USA.
Mehrdad
M
Nikfarjam
Eric T
ET
Kimchi
Niraj J
NJ
Gusani
Diego M
DM
Avella
Serene
S
Shereef
Kevin F
KF
Staveley-O'Carroll
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011312:Pressure; D011673:Pulsatile Flow; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000517:prevention & control*; D007507:Therapeutic Irrigation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing