title: Effect of technique on postoperative perineal wound infections in abdominoperineal resection.
abstract: BACKGROUND
  Perineal wound infection (PWI) after abdominoperineal resection causes a burden for patients and health systems. We sought to determine the effect of patient positioning on the incidence of postoperative surgical site infection.
  
  
  METHODS
  We conducted a retrospective cohort study of patients who underwent APR in our hospital system over a 10-year period. Univariate analysis was performed to identify characteristics associated with position and PWI. A logistic model was developed to assess the relationship of position and PWI, with adjustment for confounders.
  
  
  RESULTS
  Patient characteristics were similar for the prone and lithotomy positions. Operative time was less for the prone than for the lithotomy position. The prone position was associated with a reduced risk of PWI. After adjustment for potential confounders, the prone position remained significantly associated with a reduction in PWI.
  
  
  CONCLUSIONS
  Positioning patients in the prone position results in a lower occurrence of postoperative PWI and shorter operative time. We advocate this technique for most indications of APR.
authors.affiliation: Department of Surgery, University of Pennsylvania, 4 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: Shayna L
authors.initials: SL
authors.lastname: Showalter
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Najjia N
authors.initials: NN
authors.lastname: Mahmoud
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D056888:Patient Positioning / Q000379:methods*; D010502:Perineum / Q000601:surgery*; D016684:Prone Position; D012004:Rectal Neoplasms / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016683:Supine Position; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome