title: Abdominal closure protocol in colorectal, gynecologic oncology, and urology procedures: a randomized quality improvement trial.
abstract: BACKGROUND
  Prevention of surgical site infections (SSIs) can improve surgical quality through reductions in morbidity and cost. We sought to determine whether the abdominal closure protocol, in isolation, decreases SSI at an academic teaching hospital.
  
  
  METHODS
  Adult patients undergoing laparotomy were prospectively randomized to an abdominal closure protocol, which includes unused sterile instruments and equipment at fascial closure, or usual care. A 30-day SSI rates were compared. General surgery, colorectal, urology, or gynecologic oncology patients undergoing anticipated wound classification II cases were eligible.
  
  
  RESULTS
  Overall SSI rates were 11.6% in patients randomized to protocol closure vs 12.4% for usual care (total n = 233; P = .85). The abdominal closure protocol and usual care groups had similar rates of superficial (4.5% vs 4.1%; P = .9), deep (.9% vs 0%, P = .3), organ-space SSI rates (6.2% vs 8.3%, P = .55), and wound dehiscence (2.7% vs 5.3%; P = .24).
  
  
  CONCLUSIONS
  An abdominal closure protocol did not decrease the rate of SSI and is likely not a key intervention for SSI reduction.
authors: Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE MMC 450, Minneapolis, MN, 55455, USA. Electronic address: mkwaan@umn.edu.
authors: Mary R
authors: MR
authors: Kwaan
authors: Department of Urology, University of Minnesota, Minneapolis, MN, USA.
authors: Christopher J
authors: CJ
authors: Weight
authors: Department of Perioperative Surgical Services, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors: Stacy Jo
authors: SJ
authors: Carda
authors: Department of Perioperative Surgical Services, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors: Alyssia
authors: A
authors: Mills-Hokanson
authors: Department of Perioperative Surgical Services, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors: Elizabeth
authors: E
authors: Wood
authors: Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA.
authors: Colleen
authors: C
authors: Rivard-Hunt
authors: Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA.
authors: Peter A
authors: PA
authors: Argenta
mesh_terms: D000005:Abdomen / Q000601:surgery; D058107:Abdominal Wound Closure Techniques / Q000592:standards* / Q000639:trends; D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000601:surgery; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D058996:Quality Improvement; D018570:Risk Assessment; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D014945:Wound Healing / Q000502:physiology*
keywords: Closing tray; Colectomy; Hysterectomy; Perioperative; Surgical site infection; Urinary conduit