Research shows one in four risk of wound infection from abdominal surgery

12 August 2013

Results from a national trial led by University Hospitals Birmingham NHS Foundation Trust (UHB) have revealed that as many as one in four people who have abdominal surgery go on to develop a wound infection.

The West Midlands Research Collaborative ROSSINI study looked into the success rate of ‘wound guards’ – large sheets with a circular opening which are placed in the wound to shield the cut edges from infection. The study, which was funded by the National Institute for Health Research (NIHR) ‘Research for Benefit Programme’, looked at 760 patients across 21 hospitals across the UK.

It found that patients who were randomly assigned to a group undergoing surgery using a wound guard were just as likely to develop a wound infection as those whose surgery did not include the use of the device. In both groups, around a quarter of people developed an infection – much higher than the 10-15 per cent which was considered to be the norm from observations in other studies looking at similar operations.

Thomas Pinkney

Mr Thomas Pinkney

Mr Thomas Pinkney, Consultant Colorectal Surgeon at UHB and Senior Lecturer in Surgery at the University of Birmingham, led the trial into the use of wound guards.

He said: “Surgical site infection (or wound infection) is a worldwide problem causing suffering, distress and financial burden to patients and health services alike.”

“We undertook a clinical trial to test whether covering the cut edges of the surgical wound with a plastic sheet during the operation resulted in fewer infections at the site of surgery.”

“Whilst we robustly proved that these ‘wound-edge protection devices’ do not appear to work in reducing infection, we did identify that rates of infection after abdominal surgery were higher than previously accepted, at around 25 per cent.”

In the United Kingdom, the length of stay in hospital is typically doubled for those patients who develop an infection. Increased costs of up to £4,000 are also associated with wound infections.

Mr Pinkney suggested that the increased rate of infection in abdominal surgery in the ROSSINI trial may be due to more rigorous monitoring of patients after their discharge from hospital than would usually be the case.

“This higher rate probably reflects the fact that we bought patients back to hospital a month after their surgery to assess wounds, as well as asking patients to report wound-related events over the intervening period. We know that well over half of wound infections occur after discharge from hospital, and with the drive for shorter lengths of stay bought about by enhanced recovery programmes, more and more infections are presenting initially in the community.”

Mr Pinkney is now calling for more research to be carried out into ways of preventing infections.

He said: “Here in Birmingham we are undertaking several lines of research in this area, including designing a large trial exploring the best type of wound dressings (in conjunction with the University of Bristol), and a follow-on trial to ROSSINI testing other measures surgeons may be able to use during the operation itself to try to improve outcomes.”

The trial findings The impact of wound-edge protection devices on surgical site infection are on the BMJ website now.