■开腹手术后经常发生手术部位感染。术中伤口冲洗作为一种预防措施是世界范围内的普遍做法,尽管缺乏支持这种做法的证据。
■评估使用聚己内酯溶液进行术中伤口冲洗的预防效果。
术中伤口冲洗以防止剖腹手术后手术部位感染(IOWISI)试验是一项多中心试验,三臂,随机临床试验。患者和结果评估者对干预措施视而不见。该临床试验于2017年9月至2021年12月在德国12所大学和综合医院进行,为期30天的随访。接受剖腹手术的成年患者有资格入选。主要排除标准是干净的腹腔镜手术和无法提供同意。在11700筛选中,689人被纳入试验,557人完成试验;689人被纳入意向治疗和安全性分析。
■在线(3:3:1分配)对0.04%的聚己内酯进行随机化,盐水,或在闭合前不冲洗(控制)手术伤口。
■根据美国疾病控制和预防中心的定义,主要终点是术后30天内的手术部位感染。
■在包括的689名患者中,男性402人,女性287人。中位(范围)年龄为65.9(18.5-94.9)岁。参与者被随机分配使用聚己内酯(n=292)进行伤口冲洗,生理盐水(n=295),或不灌溉(n=102)。92例(8%)的程序被归类为清洁污染。手术部位感染的总体发生率为11.8%(689个中的81个),聚己酰胺臂中的10.6%(292个中的31个),盐水臂中的12.5%(295个中的37个),在无灌溉臂中占12.8%(102个中的13个)。用聚己内酯灌溉在统计学上并不优于不灌溉或盐水灌溉(危险比[HR],1.23;95%CI,0.64-2.36vsHR,1.19;95%CI,0.74-1.94;P=.47)。严重不良事件的发生率在3组之间没有差异。
■在这项研究中,在清洁污染的开腹手术中,与生理盐水或无冲洗相比,术中使用聚己内酯溶液冲洗伤口并不能降低手术部位感染的发生率.有必要进行更多的临床试验,以评估污染和败血症程序的潜在益处。包括紧急设置。
■drks.de标识符:DRKS00012251。
UNASSIGNED: Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking.
UNASSIGNED: To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution.
UNASSIGNED: The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI)
trial was a multicenter, 3-armed, randomized clinical
trial. Patients and outcome assessors were blinded to the intervention. The clinical
trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the
trial; 689 were included in the intention-to-treat and safety analysis.
UNASSIGNED: Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure.
UNASSIGNED: The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition.
UNASSIGNED: Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups.
UNASSIGNED: In this
study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting.
UNASSIGNED: drks.de Identifier: DRKS00012251.