Feasibility of subcutaneous gentamicin and pressurized irrigation as adjuvant strategies to reduce surgical site infection in colorectal surgery: results of a pilot study

Am Surg. 2015 Jun;81(6):573-9.

Abstract

Surgical site infections (SSIs) remain a common and costly morbidity after colorectal surgery. This rate remains high even in the setting of strict adherence to Surgical Care Improvement Project Protocols. The aim of our pilot study was to determine the feasibility and safety of subcutaneous gentamicin injection or pressurized irrigation as adjuncts to reduce SSI. A total of 132 patients who underwent colorectal surgery at the VA North Texas Health Care System were prospectively assigned to a pressurized irrigation group (n = 44), a preincision gentamicin injection group (n = 48), or control (n = 40). The primary objective was to assess safety and feasibility of these strategies. Patient demographics were matched among groups. Univariate and multivariate analyses were performed to identify possible predictions of SSI in this cohort. The rate of SSI in the control group was 25 per cent, 13.5 per cent in the pressurized irrigation group, and 12.5 per cent in the gentamicin group (P = 0.26). Combined, the intervention groups had a 13 per cent SSI versus 25 per cent control (P = 0.09). Operative time was not increased by the interventions and no intraoperative complications specifically related to the interventions were noted. Postoperative complications were not different between groups. Both albumin and body mass index were associated with SSI. Body mass index was and independent predictor of SSI (P = 0.006). In conclusion, this pilot study demonstrates the feasibility of the interventions described. There was no detrimental effect of either intervention. There was trend toward a reduction in SSI in the intervention group, which warrants further investigation.

Trial registration: ClinicalTrials.gov NCT01153191.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / adverse effects
  • Body Mass Index
  • Colorectal Surgery
  • Feasibility Studies
  • Gentamicins / administration & dosage*
  • Gentamicins / adverse effects
  • Humans
  • Inflammatory Bowel Diseases / surgery*
  • Infusions, Subcutaneous / adverse effects
  • Infusions, Subcutaneous / methods
  • Injections, Subcutaneous
  • Intestinal Neoplasms / surgery*
  • Intestinal Polyps / surgery*
  • Middle Aged
  • Operative Time
  • Pilot Projects
  • Pressure
  • Prospective Studies
  • Safety
  • Serum Albumin / analysis
  • Surgical Wound Infection / drug therapy*
  • Surgical Wound Infection / prevention & control
  • Therapeutic Irrigation / adverse effects
  • Therapeutic Irrigation / methods*

Substances

  • Anti-Bacterial Agents
  • Gentamicins
  • Serum Albumin

Associated data

  • ClinicalTrials.gov/NCT01153191