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Colorectal surgery

Introduction

Colorectal Surgery is considered to have the highest Surgical Site Infection rate and is among the most expensive to treat (Tanner et al, 2009).

Whilst infection is the most common incision site complication following surgery, in some cases wound breakdown may occur as a result of other factors. This can result in wound dehiscence that requires additional treatment or surgery.

A recent study by Jenks et al (2014) reported:

  • An Infection rate of 12.8% Large Bowel procedures and 9.3% Small Bowel procedures (110 surgical site infections in 932 procedures)
  • Surgical Site Infections (SSI) during admission: Large Bowel procedures 6.1% and Small Bowel procedures 5.8%
  • SSI on readmission: Large Bowel procedures 1.8% and Small Bowel procedures 0.4%
  • Post Discharge SSI: Large Bowel procedures 4.9% and Small Bowel procedures 3.1%

Obesity and Diabetes are strongly associated with an increased risk of developing an infection (superficial/deep):

  • Analysis of patients with a BMI≥30 uncovered a 48% SSI rate in this patient group (11/21)
  • Patients with Diabetes Mellitus were associated with a 34.9% SSI rate

SSI are associated with considerable morbidity and contribute to additional healthcare resource use and costs. In many cases, SSI are associated with extended length of hospital stay or readmissions to manage complications (Tanner et al 2009).

In this same study from Sweden the investigators found that over 35% of patients
suffer with a post-operative complication following colorectal surgery and of these
13.9% were specifically related to wound complications (Zougas and Lydrup, 2014).

The impact of these complications can be seen in the results of this
retrospective study:
• Reoperation in 10.4 % of patients
• Readmission rate of 7.4%
• Length of stay increased by 78%
• Failure of suture lines equated a 6-fold increase in ward costs
• Wound dehiscence or deep wound infection equated to a 4.5 fold
increase in ward costs.

The burden to the hospital is clear and complications will of course negatively
impact the patient experience as they try to recover from surgery.

NICE reports that the cost to the NHS of surgical site infections is around £700m a year based on an estimated cost per infection of £3,486.

A recent study from a single NHS trust estimated that the costs of an SSI following colorectal surgery were £4,928 for large bowel procedures and £6,198 for small bowel procedures (Jenks et al 2014).  The attributable length of stay associated with the presence of an SSI was found to be 12 bed days for Small Bowel procedures and 11 bed days for Large Bowel procedures.  

In many cases SSI are associated with extended length of stay both at admission and via readmission due to complications.  Furthermore there may be monetary and non-monetary costs incurred by the patient, including psychosocial impacts, functional capacity, workplace costs and lost productivity.

As surgical case loads are progressively more complex and high-risk patients are increasingly common, it's more critical than ever to protect against post-operative complications.

PICO can help

Improving outcomes with incisional NPWT

Negative Pressure Wound Therapy (NPWT) has a mechanism of action that improves the speed, strength and quality of incisional wound healing, thus minimising the failures of healing that lead to infection and/or dehiscence.

PICO Incision MOA

Considerable evidence shows NPWT delivers clinical benefits as part of effective incision management.1

Introducing PICO

PICO is a novel, canister- free, single-use system offering the ultimate in portable, accessible and affordable NPWT.

PICO Delivers Active Therapy

In a recent publication on surgical wounds of patients affected with Crohn's disease, 50 patients were assigned post-operative treatment with PICO or conventional dressings.  Patients receiving PICO had fewer surgical site complications, resulting in a shorter hospital stay.  Hospital readmissions were also lower in the PICO group (Selvaggi et al 2014).

Colorectal surgery

References

  1. Karlakki S et al, Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery, Bone Joint Res 2013; 2:276-84.

Recommended Pathway and Clinical Cases

Stannard et al (2009)1 proposed a grading system based on existing knowledge of risk factors for infection and dehiscence, seroma and hematoma.

  • Grade 1 – No risk factors
  • Grade 2 – Single risk factor
  • Grade 3 – Multiple risk factors

Known risk factors are diabetes, obesity, smoker, hypertension etc.

Results suggest that at-risk patients may benefit from NPWT immediately post-op; click here to see our Risk Identification pathway, which can help determine at-risk patients.

References

  1. Stannard JP et al.  Use of negative pressure therapy on closed surgical incisions: a case series.  Ostomy Wound Manage. 2009 Aug 1;55(8):58-66.

Economic Benefits

Prevention of complications is cheaper than the cure

11 Bed Days

Large Bowel surgery
SSI = Additional 11 days in hospital1 

In Hip replacement an SSI can doublethe cost of surgery

In Large Bowel surgery, an SSI can
double the cost of surgery1

12 Bed Days

Small Bowel surgery
SSI = Additional 12 days in hospital1 

In Hip replacement an SSI can doublethe cost of surgery

In Small Bowel surgery, an SSI can
double the cost of surgery1

References

  1. Jenks et al. (2014), Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital.  Journal of Hospital Infection; 86. 24-33.

PICO Video

This video shows how PICO aids wound healing on incisions, and how its mode of action compares to a standard dressing.