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      O-Ring Protector in Prevention of SSIs in Laparoscopic Colorectal Surgery

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          Abstract

          Background:

          Surgical-site infections (SSIs) remain a serious complication of colorectal surgery, causing a significant financial burden to the health care system. The aim of this study is to investigate whether the use of an O-ring retractor can be effective in preventing the incidence of wound infections after elective laparoscopic colorectal surgery.

          Methods:

          A retrospective case-control study from January 2014 to June 2018 was performed. Data were analyzed from a retrospective colorectal database. SSI was defined according to criteria published by the European Centre for Disease Prevention and Control and analyzed as a primary outcome.

          Results:

          Three hundred twelve consecutive patients (n = 312) were enrolled in our study. Among them, 158 patients (Group A) in which an O-ring retractor device was used during surgery was compared with a control group of 154 patients (Group B) in which an O-ring retractor device was not used. Primary outcome was to determine SSIs rates among the 2 groups. No statistically differences were observed with regard to baseline characteristics between both groups. A total of 9 patients (5.69%) and 24 (15.58%) with SSIs were identified in Group A and B, respectively, and the difference was statistically significant (OR, 0.32; 95% CI, 0.14–0.72; P = .0045). The median postoperative hospital stay length was 6.7 days in group A and 7.6 days in group B ( P ≤ .05).

          Conclusions:

          SSIs infections rates were significantly higher in patients in which an O-ring retractor device was not used. This study suggests that the use of a wound protector device can be considered for routine use in elective colorectal surgery.

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          Most cited references23

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          Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery.

          To determine the relationship between oral antibiotic bowel preparation (OABP) and surgical site infection (SSI) rates in a national colectomy cohort.
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            Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients.

            Care bundles are a strategy that can be used to reduce the risk of surgical site infection (SSI), but individual studies of care bundles report conflicting outcomes. This study assesses the effectiveness of care bundles to reduce SSI among patients undergoing colorectal surgery.
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              Surgical site infection prevention: time to move beyond the surgical care improvement program.

              The objective of this study was to evaluate whether the Surgical Care Improvement Project (SCIP) improved surgical site infection (SSI) rates using national data at the patient level for both SCIP adherence and SSI occurrence. The SCIP was established in 2006 with the goal of reducing surgical complications by 25% in 2010. National Veterans' Affairs (VA) data from 2005 to 2009 on adherence to 5 SCIP SSI prevention measures were linked to Veterans' Affairs Surgical Quality Improvement Program SSI outcome data. Effect of SCIP adherence and year of surgery on SSI outcome were assessed with logistic regression using generalized estimating equations, adjusting for procedure type and variables known to predict SSI. Correlation between hospital SCIP adherence and SSI rate was assessed using linear regression. There were 60,853 surgeries at 112 VA hospitals analyzed. SCIP adherence ranged from 75% for normothermia to 99% for hair removal and all significantly improved over the study period (P < 0.001). Surgical site infection occurred after 6.2% of surgeries (1.6% for orthopedic surgeries to 11.3% for colorectal surgeries). None of the 5 SCIP measures were significantly associated with lower odds of SSI after adjusting for variables known to predict SSI and procedure type. Year was not associated with SSI (P = 0.71). Hospital SCIP performance was not correlated with hospital SSI rates (r = -0.06, P = 0.54). Adherence to SCIP measures improved whereas risk-adjusted SSI rates remained stable. SCIP adherence was neither associated with a lower SSI rate at the patient level, nor associated with hospital SSI rates. Policies regarding continued SCIP measurement and reporting should be reassessed.
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                Author and article information

                Contributors
                Journal
                JSLS
                JSLS
                jsls
                jsls
                JSLS
                JSLS : Journal of the Society of Laparoendoscopic Surgeons
                Society of Laparoendoscopic Surgeons (Miami, FL )
                1086-8089
                1938-3797
                Oct-Dec 2019
                : 23
                : 4
                : e2019.00048
                Affiliations
                Department of Geriatric Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy.
                Department of Geriatric Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy.
                Department of Geriatric Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy.
                Department of Geriatric Surgery Unit, Campus Bio-Medico of Rome University, Rome, Italy.
                Unit of Clinical Laboratory Science, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy.
                Unit of Medical Statistic and Epidemiology, Department of Medicine, Campus Bio-Medico of Rome University, Rome, Italy.
                General Surgery Unit, Campus Bio-Medico of Rome University, Italy.
                MD Program, School of Medicine, Catholic University of Sacred Heart, City, State, Country.
                Author notes

                Disclosures: none.

                Funding/Financial Support: none.

                Conflicts of Interest: The authors have no conflicts of interest directly relevant to the content of this article.

                Informed consent: Dr. Lauricella declares that written informed consent was obtained from the patient/s for publication of this study/report and any accompanying images.

                Address correspondence to: S. Lauricella, MD, Department of Geriatric Surgery, Campus Bio-Medico of Rome University 00100, Rome, Italy. Phone: +393337094089; Fax: 06225411908; E-mail: s.lauricella@ 123456unicampus.it
                Article
                JSLS.2019.00048
                10.4293/JSLS.2019.00048
                6924502
                31892788
                58795b00-b063-497d-9c17-1a710fd59055
                © 2019 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License ( http://creativecommons.org/licenses/by-nc-nd/3.0/us/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.

                History
                Categories
                Research Article

                Surgery
                alexis®,wound protector/retractor,prevention,surgical site infection,colorectal
                Surgery
                alexis®, wound protector/retractor, prevention, surgical site infection, colorectal

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