Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy

Effect of Pulsed Lavage on Surgical Site Infection in Abdominal Surgery: A Systematic Review and Meta-Analysis

Objective: To evaluate the effect of pulsed lavage on the risk of surgical site infection in patients undergoing abdominal. Methods: A systematic review and meta-analysis was conducted in compliance with PRISMA statement standards. We evaluated all studies comparing pulsed lavage and standard practice in patients undergoing abdominal surgery. Surgical site infection was the outcome measure. Random-effects modeling was applied for the analyses. The certainty of the evidence was assessed using the grade system. Results: Five studies including 747 patients were included. The operations in both groups were comparable in terms of elective (RD: 0.00, 95% CI -0.02-0.03, P = 0.85) or emergency setting (RD: -0.00, 95% CI -0.03-0.02, P = 0.85) and open (RD: 0.00, 95% CI -0.02-0.02, P = 0.94) or laparoscopic approach (RD: -0.00, 95% CI -0.02-0.02, P = 0.94). Pulsed lavage was associated with a reduced risk of surgical site infection compared with no pulsed lavage (OR: 0.31, 95% CI 0.20-0.48, P < 0.00001). The between-study heterogeneity was low (I2 = 0%), and the grade certainty was high. The results were consistent through subgroup analysis of randomized controlled trials (OR: 0.28, 95% CI 0.15-0.52, P < 0.0001), observational studies (OR: 0.35, 95% CI 0.19-0.64, P = 0.0007), patients undergoing elective operation (OR: 0.31, 95% CI 0.16-0.62, P = 0.0009), emergency operation (OR: 0.28, 95% CI 0.14-0.58, P = 0.0006), and open operation (OR: 0.30, 95% CI 0.16-0.55, P = 0.0001). Conclusions: Robust evidence suggests that pulsed lavage reduces the risk of surgical site infection in patients undergoing abdominal surgery. We do not hesitate to recommend the routine use of pulsed lavage in abdominal surgery in both emergency and elective settings.

Wound Irrigation in the Prevention of Surgical Site Infection in Elective Colorectal Surgery: A Retrospective Cohort Study

Background Surgical site infection in colon surgery is associated with significant cost and increased length of hospital stay. Recently, there has been interest in the use of pulsed lavage to reduce the risk of surgical site infection in contaminated wounds. Although increasingly used and gaining popularity, its effectiveness in elective colorectal surgery has been poorly documented. This study aimed to investigate the incidence of surgical site infection within 30 days of elective colorectal surgery in patients who underwent wound irrigation with pulse lavage versus standard closure. Methodology A retrospective study was conducted at a university hospital over a two-year period between January 2020 and December 2021. All adult patients who underwent elective colorectal surgery were eligible for inclusion. Results A total of 222 patients underwent elective colorectal surgery during the study period. Operative procedures included abdominoperineal resections, left and right hemicolectomies, pelvic exenterations, small bowel or large bowel resections, as well as stoma reversals, formations, and refashioning. In total, 76 patients underwent pulse lavage while 146 did not. The total number of surgical site infections was 39 during the study period. Infection rates in the pulse lavage group were 14.47% compared to 19.18% in the standard closure group. The chi-square analysis concluded the difference in infection rates was not statistically significant (p = 0.213). Conclusions The findings demonstrated a difference in infection rates of almost 5% favouring the pulse lavage group; however, it did not reach a statistical difference. Although infection rates were in keeping with those described in the literature, further studies in the form of randomized controlled trials should be performed to determine the benefits, if any, of pulse lavage in colorectal surgery.

The Cost-Effectiveness of Normal-Saline Pulsed Lavage for Infection Prophylaxis in Total Joint Arthroplasty

Background

Prosthetic joint infection (PJI) is a well-described complication after total joint arthroplasty which imposes a substantial burden of morbidity and mortality on the individual, as well as cost to the health-care system. This study used a break-even analysis to investigate the cost-effectiveness of pulsed saline lavage (PSL) for PJI prophylaxis after a primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Methods

An established model was used to calculate the minimum cost-effective absolute risk reduction of PSL for infection prophylaxis after a total joint arthroplasty. Baseline infection rates of TKA and THA and the cost of a revision surgery for PJI were derived from the literature while the cost of PSL implementation was obtained from institutional data.

Results

PSL is cost-effective at an initial infection rate of 1.10%, revision costs of $32,132 for TKA PJI, and a protocol cost of $38.28 if it reduces infection rates by 0.12% or prevents infection in 1 out of 839 patients. PSL is cost-effective at an initial infection rate of 1.63% and a revision cost of $39,713 for THA PJI if it reduces infection rates by 0.10% or prevents infection in 1 out of 1037 patients. The absolute risk reduction needed for economic viability did not change with varying baseline infection rates and did not exceed 0.38% for infection treatment costs as low as $10,000 and remained less than 0.47% even if PSL cost was as high as $150.

Conclusions

The use of PSL is a cost-effective protocol for PJI prophylaxis after TKAs and THAs.

Surgical strategy for treating mycotic aneurysms of thoracic and abdominal aorta and iliac artery: analysis of long-term follow-up data

Mycotic aneurysms of the aorta and iliac arteries are rare, but life-threatening conditions. We reviewed our experience to determine the best surgical strategy. Between 2007 and 2015, we operated 14 patients with mycotic aneurysms of the aortic arch (n  =  6), descending aorta (n  =  1), thoracoabdominal aorta (n  =  2), abdominal aorta (n  =  4), and iliac artery (n  =  1). The mean age was 70.4  ±  8.8 years, and 10 males were included. Blood culture, tissue culture, or both were positive in 11 patients. Four of five patients with mycotic aneurysms of the abdominal aorta and iliac artery underwent extra-anatomical bypass. Ten underwent in-situ graft replacement for managing mycotic aneurysms of the thoracic aorta. One patient with a mycotic thoracoabdominal aortic aneurysm underwent visceral bypass of the descending aorta and extra-anatomical bypass. Omental pedicle grafting was performed in 10 patients. The mean follow-up period was 8.6  ±  3.1 years. Three patients (21.4%) died. Recurrent infection was observed in one patient with a mycotic aneurysm of iliac artery three months after the initial surgery. The patient underwent extra-anatomical bypass with omental pedicle grafting as a redo. Nine patients were discharged, and no recurrence of infection was observed. Two patients died of cancer and heart failure. The five- and seven-year survival rates were 100% ± 0.0% and 85.7% ± 13.2%, respectively. A combination of radical debridement of the infectious source and omental pedicle grafting with either in-situ graft replacement or extra-anatomical bypass is an effective strategy.