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Reduction of surgical site infections by use of pulsatile lavage irrigation after prolonged intra-abdominal surgical procedures
Authors:Mehrdad Nikfarjam M.D.   Ph.D.   Eric T. Kimchi M.D.   Niraj J. Gusani M.D.   Diego M. Avella M.D.   Serene Shereef M.D.  Kevin F. Staveley-O'Carroll M.D.   Ph.D.  
Affiliation:aSection of Surgical Oncology, Department of Surgery, Milton S. Hershey Medical Center, 500 University Dr., PO Box 850, Hershey, PA 17033-0850
Abstract:

Background

Surgical site infections cause significant postoperative morbidity and may be reduced by pressurized irrigation of high-risk laparotomy wounds before closure. This was a retrospective review (June 2007 to May 2008) from a surgical unit at a tertiary care center.

Methods

Patients undergoing laparotomy extending beyond 4 hours, when a standard wound management strategy was instituted by either simple irrigation or pressurized pulsatile lavage (<15 psi) with saline before closure, were included. The outcome measures were the surgical site infections and factors contributing to them.

Results

The median surgical time for the patients was 8 hours, with 34 wounds managed by simple irrigation and 42 wounds managed by pulse irrigation. Both groups had similar characteristics. Overall there were 15 (20%) surgical site infections. Significantly fewer infections occurred in the pulse irrigation group (10% vs 32%; P = .019). The use of a pulse irrigation device was the only factor associated with a reduction in wound infections (P = .019).

Conclusions

Surgical site infections appear to be reduced with pulsatile lavage irrigation of wounds before skin closure in patients undergoing prolonged intra-abdominal surgeries.
Keywords:Wound infection   Wound irrigation   Pulse lavage irrigation   Pressure   Laparotomy   Fat necrosis
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