A comparison of primary closure versus delayed primary closure in contaminated abdominal surgery in terms of surgical site infection

Abstract

Objective: To compare the frequency of surgical site infection in patients undergoing delayed primary closure(DPC) with those undergoing primary closure (PC) of surgical wounds after abdominal surgery forperforated appendix, perforated duodenal ulcer and ileal perforation.

Methodology: This quasi-experimental study was carried out at Surgical Unit I at Benazir Bhutto Hospitalfrom January 2011 to December 2011. Patients undergoing contaminated abdominal surgery includingperforated appendix, duodenal perforation and ileal perforations were recruited through the emergency department.The study included 86 patients, 43 in the primary closure (PC) and 43 in delayed primary closure(DPC) groups. They were followed for evidence of surgical site infection (SSI) for 30 days.

Results: Out of 86 patients 43 (50%) had ileal perforation, 26 (30.2%) had duodenal perforation and 17(19.8%) had appendicular perforation. The mean age was 28.9±8.7 years. 32 (37.2%) were males and 54(62.8%) were females. Both groups were similar with respect to age, gender distribution and indication forsurgery. SSI was diagnosed in 19.8% patients. 30.2% in the PC group and 9.3% in the DPC group developedSSI. Hence significantly greater proportion of PC group patients developed SSI as compared to DPCpatients; p=0.015. The severity if infection (superficial, deep or organ space) was not significantly differentbetween the PC and DPC groups; p= 0.378. Significantly greater wound dehiscence was encountered inPC group; p=0.011.

Conclusion: There frequency of SSI was significantly lower after delayed primary closure of contaminatedwounds as compared to primary closure.Key Words: Wound infection, Surgical site infection (SSI), Primary closure, Delayed primary closure, Contaminatedabdominal wounds.