title: Does primary closure increase surgical site infection after intestinal stoma reversal? A retrospective cohort study.
abstract: BACKGROUND
  This study was undertaken to test the veracity of the hypothesis that primary incision closure after intestinal stoma reversal in adult patients is associated with a greater risk of surgical site infection (SSI) than are open incisions.
  
  
  METHODS
  A retrospective cohort study was conducted at the Surgical Department of the Aga Khan University Hospital, Karachi, Pakistan. The study included adult patients who underwent elective loop and double-barreled intestinal stoma (ileostomy or colostomy) reversal through peristomal incisions between January 2005 and May 2011. Files were reviewed independently by two surgeons to establish main exposure (closed or open surgical sites) and outcome; i.e., SSI based on U.S. Centers for Disease Control and Prevention criteria.
  
  
  RESULTS
  Sample size calculation prior to the study required 71 patients to be included in each exposure arm. Patients with closed surgical sites were relatively younger (mean 36±15 [standard deviation] years) than those with open surgical sites (41±15 years), with a male preponderance in both groups. Fifteen patients were found to have SSI: 3/71 (4.2%) in open and 12/71 (16.9%) in closed incisions. The risk of SSI in closed surgical sites was 5.8 times greater than in open sites (95% confidence interval for relative risk 1.5-22.5) after adjusting for gender, body mass index (BMI), site of stoma, malignant disease, and preoperative chemo-radiotherapy.
  
  
  CONCLUSIONS
  The risk of SSI in closed incisions is greater than that in open incisions. It is suggested that incisions not be closed primarily in patients undergoing stoma reversal.
authors.affiliation: 1 Department of Surgery, The Aga Khan University Hospital , Karachi, Pakistan .
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
authors.forename: Rozina
authors.initials: R
authors.lastname: Nuruddin
authors.forename: Ayaz Ahmad
authors.initials: AA
authors.lastname: Memon
authors.forename: Tabish
authors.initials: T
authors.lastname: Chawla
authors.forename: Iqbal
authors.initials: I
authors.lastname: Azam
authors.forename: Yasir
authors.initials: Y
authors.lastname: Mukhtar
mesh_terms: D000293:Adolescent; D000328:Adult; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007422:Intestines / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology* / Q000517:prevention & control; D058106:Wound Closure Techniques / Q000009:adverse effects; D055815:Young Adult