The Results of a Propensity Score Matching Analysis of the Efficacy of Abdominal Fascia and Skin Closure Using PDS® Plus Antibacterial (Polydioxanone) Sutures on the Incidence of Superficial Incisional Surgical Site Infections after Gastroenterologic Surgery.
BACKGROUND
Surgical site infections (SSIs) lead to prolonged hospitalization and increased cost of hospital stay after surgery. Therefore, the prevention of SSIs is one of the most critical tasks facing surgeons and nursing staff. In the present study, the efficacy of using triclosan-coated polidioxanone sutures (PDS® Plus Antibacterial Suture, (Ethicon Inc., Somerville, NJ) for abdominal closure was analyzed retrospectively using a propensity score matching analysis.


METHODS
Of 1,768 patients who underwent gastroenterologic surgery at Fukuoka University Hospital between January 2009 and September 2013, 812 underwent abdominal closure using PDS Plus. These patients were compared retrospectively regarding the incidence of SSIs using a propensity score matching method with 956 patients treated in the previous period without abdominal closure using PDS Plus sutures. The propensity score was calculated from the age, gender, body mass index, smoking status, diabetes mellitus, use of steroid medication, malignant or benign disease, organ location, emergency or planned surgery, wound classification, the American Society of Anesthesiologists score, open or laparoscopic surgery, the length of the operation, and blood loss.


RESULTS
Nine hundred sixty-six patients (483 matched sets) were enrolled by the propensity score matching method. No parameter used for the propensity score was different between the PDS Plus and control groups. Closure using PDS Plus could reduce the incidence of SSIs compared with that in the control group (p = 0.022). Of the parameters used for the propensity score, malignant disease (p = 0.0002), open surgery (p = 0.0020), a prolonged operation (p < 0.0001), high blood loss (p < 0.0001), the need for a transfusion (p = 0.019), and gastrointestinal tract surgery (p = 0.0059) were significant risk factors for the development of SSIs in the univariable analysis. In a multivariable regression model, open surgery (p < 0.0001), prolonged operation (p < 0.0001), gastrointestinal tract surgery (p = 0.001), and abdominal closure without PDS Plus (p < 0.0001) were the independent risk factors for the development of an SSI. The development of an SSI prolonged the hospital stay (p < 0.0001) and the use of antibiotic medication (p < 0.0001); abdominal closure using PDS Plus affected the antibiotic medication period (p = 0.013) but not the hospital stay (p = 0.40).


CONCLUSIONS
Although abdominal fascia and skin closure using PDS Plus was compared with variable abdominal closure, the present findings suggest that abdominal fascia and skin closure using PDS Plus sutures could help prevent the development of SSIs after gastroenterologic surgery, as determined by a propensity score matching analysis.
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine , Fukuoka City, Fukuoka, Japan .
Shinsuke
S
Takeno
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine , Fukuoka City, Fukuoka, Japan .
Kanefumi
K
Yamashita
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine , Fukuoka City, Fukuoka, Japan .
Yuichi
Y
Yamashita
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine , Fukuoka City, Fukuoka, Japan .
Kazunosuke
K
Yamada
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine , Fukuoka City, Fukuoka, Japan .
Seichiro
S
Hoshino
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine , Fukuoka City, Fukuoka, Japan .
Yasushi
Y
Yamauchi
Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine , Fukuoka City, Fukuoka, Japan .
Tomoaki
T
Noritomi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005205:Fascia / Q000473:pathology; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016687:Polydioxanone; D057216:Propensity Score; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control*; D013537:Sutures; D058106:Wound Closure Techniques
D000900:Anti-Bacterial Agents; D016687:Polydioxanone