Amirali Shakouripartovi, MD, FRCSC, Fatima A Haggar, MPH, PhD, Andrey Vizhul, MD, FRCSC, Jean Denis Yelle, MD, FRCSC, Joseph Mamazza, MD, FRCSC, FACS, Amy Neville, MD, MSC, FRCSC. The Ottawa Hospital
Morbid obesity is associated with an increased risk of postoperative complications, including surgical site infections (SSIs). SSIs significantly impact length of hospital and health care costs. There is good evidence that wound protectors for digestive tract surgery decrease the incidence of SSIs, but to date it remains unclear if this provides benefit in Laparoscopic Roux-en-Y Gastric Bypass (LRNYGB). Circular stapled anastomosis is associated with an increased risk of SSI presumably due to contamination of the trocar site from insertion/removal of the Orvil and the EEA stapler. The objective of this study is to examine the effect of using a wound protector on SSI’s after LRNYGB with circular-stapled gastrojejunostomy.
The study population included patients undergoing LRNYGB for morbid obesity between May 2010 and December 2013 at The Ottawa Hospital Bariatric Center of Excellence. Eligible patients were those included in routine National Surgical Quality Improvement Program (NSQIP) data collection. The main outcome of interest was SSI, defined as any infection of the superficial or deep tissues occurring within 30 days of surgery (as per NSQIP definitions). Patients were operated on by one of three surgeons; one of whom used a wound protector (sterile plastic sheath) at the trocar site of EEA stapler and Orvil insertion/extraction. Patient care was otherwise the same and followed a standardized postoperative pathway. Logistic regression model was used to investigate the association between the use of wound protection, preoperative and baseline patient characteristic and the occurrence of SSIs.
Two hundred and thirty eight (n=238) LRNYGB surgery patients, (wound protector, n=68; without wound protector n=170) were included. There was no statistical difference in baseline demographics including the rate of diabetes, COPD, hypertension, or smoking status. Re-operation and readmission rates were similar between the two groups. The overall wound infection rate was 14.7% (wound protector: 8.8% vs. without: 17.1%). There was a non-significant trend toward lower SSIs associated with the use of wound protector (odds ratio [OR], 0.53; 95% CI, 0.21-1.33; p-value=0.18). Each unit increase in BMI was associated with a 7% increase in the odds of SSIs (OR, 1.07; CI, 1.02-1.12; p-value=0.004).
The use of barrier wound protection may lead to a reduction in SSI but this did not prove significant, potentially on the basis of a small sample size in this study. In obese patients, higher BMI appeared to be the greatest determinant of SSI. Further, larger studies are required to confirm potential effect of wound protection on SSI following LRNYGB surgery.