EP.FRI.16 Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy

Aims Surgical site infections (SSIs) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is currently limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies. Methods Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following STROBE criteria. The primary outcome was rate of superficial SSIs within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis. Results 176 patients were identified, with an average age of 60.7 ±19.1 years. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty two patients (29.5%) had PL used during their operation. Thirty seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (p = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, p = 0.047) for developing a SSI. Conclusions PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.

The effect of pulsed lavage irrigation on suture knot security

Purpose: The purpose of this study was to determine the effect of low-pressure and pulsed lavage irrigation on suture knot security. Methods: Ninety-tied suture loops were measured for baseline circumference and then subjected to no irrigation, bulb syringe irrigation, or pulsed lavage irrigation. The sutures were placed under a load and then measured for final circumference. A larger circumference difference indicated poorer knot security. Results: There was a statistically significant difference in the knot security between all three groups ( p < 0.001). Pulsed lavage resulted in the greatest circumference increase (0.52 ± 0.19 mm), followed by bulb syringe (0.24 ± 0.18 mm), and lastly no irrigation (0.08 ± 0.00 mm). None of the groups had any catastrophic failures. No knots met the predetermined criteria for knot failure. Conclusion: Pulsed lavage irrigation resulted in a statistically significant decrease in suture knot security as compared to bulb syringe irrigation and no irrigation. None of the groups met the currently accepted criteria for clinical suture failure, which has a relatively arbitrary value. While the available literature does not discuss increases in loop circumference for specific orthopedic applications, this small difference suggests that pulse lavage is unlikely to have a clinically significant impact on the suture integrity for most orthopedic procedures.