Prophylactic PICO◊ dressing shortens wound dressing requirements post emergency laparotomy (EL-PICO◊ trial)
Document Type
Article
Publication Date
11-1-2024
Abstract
Background Surgical site infection (SSI) is a very common complication of emergency laparotomy and causes significant morbidity. The PICO lozenge device delivers negative pressure wound therapy (NPWT) to closed incisions, with some studies suggesting a role for prevention of SSI in heterogenous surgical populations. We aimed to compare SSI rates between patients receiving PICO lozenge versus conventional dressing post-emergency laparotomy. Secondary objectives were to observe seroma and dehiscence rates, length of stay, days on dressing and patients' wound experience. Methods This double blinded randomized controlled trial was conducted in University Malaya Medical Centre between October 2019 and March 2022. Patients undergoing emergency laparotomy requiring incisions less than 35 cm were included. Statistical analysis was performed using chi 2 test for categorical variables, independent T-test or Mann-Whitney U were used for parametric or non-parametric data respectively besides logistic regression. P values of < 0.05 were considered to be significant. Results Ninety-six patients were analyzed (47 interventions, 49 controls). The duration on dressing was more consistent in the intervention arm (PICO lozenge) versus control arm 9.78 +/- 10.20 vs 17.78 +/- 16.46 days, P < 0.001]. There was a trend towards lower SSI 14.3 vs 4.3%, P = 0.09], dehiscence 27.1 vs 10.6%, P = 0.07] and seroma 40.8 vs 23.4%, P = 0.08] rates in the intervention arm but this did not reach statistical significance. Length of stay 9 (IQR: 6-14) vs 11 (IQR: 6-22.5) days, P = 0.18] was fairly similar between the two arms, but more patients were very satisfied with PICO lozenge compared to the conventional dressing 80% vs 57.1%, P = 0.03]. Conclusion The use of NPWT in emergency laparotomy improves patients wound care experience, and was associated with trends towards fewer wound related complications. Cost effectiveness needs to be explored in order to further validate its use in the emergency setting, especially for patients with additional risk for SSI.
Trial registration National Medical Research Registry (NMRR): NMRR-20-1975-55222.
Keywords
Emergency laparotomy, Negative pressure wound therapy, PICO lozenge dressing, Surgical site infection
Divisions
surgerydept
Funders
University Malaya Specialist Centre (UMSC) C.A.R.E Fund,Universiti Malaya
Publication Title
World Journal of Emergency Surgery
Volume
19
Issue
1
Publisher
BMC
Publisher Location
CAMPUS, 4 CRINAN ST, LONDON N1 9XW, ENGLAND