Effectiveness of Early Versus Late Dressing Removal in Contaminated and Clean Surgical Wounds

Aim: This study was conducted to assess the effectiveness of early versus late dressing removal in contaminated and clean surgical wounds. Study design: A Prospective non-randomized study. Place and duration: In the Surgical Unit of AllamaIqbal Teaching Hospital, Sialkot from March 2018 to March 2019. Method: Sixty patients age eighteen or above (planned surgery and emergency surgery) were enrolled in the study, admitted in hospital and operated. All surgical wounds met the criteria of contaminated and clean surgical wounds. Thirty patients were included in each group with early and late dressing removal. In the early removal group, within 48 hours, the surgical dressing was removed and in the late group 48 hours after surgical intervention. The incidence of deep and superficial surgical site (SSI) infection was studied in these two groups. Additional subordinate factors such as dehiscence of wound incidence and secondary suturing were too assessed. Results: Thirty patients were included in each group with early and late dressing removal for final scrutiny. The occurrence of superficial surgical sight infection was lower expressively in the early dressing removal group. The time required for full recovery (days) (8.60-10.70; p=0.734) was shorter considerably in the early dressing removal group. In the early dressing removal group, there was the significantly shorter postoperative hospital stay (days) (10.50 vs. 15.0; p ≤ 0.001). Conclusion: Early dressing removal considerably decreases the superficial SSIs incidence in contaminated and clean surgical wounds. It also considerably decreases the time of full wound healing and facilitates short hospital stay as compared to late dressing removal.

Pre-operative Serum Albumin and Neutrophil- Lymphocyte Ratio are Associated with Prolonged Hospital Stay Following Colorectal Cancer Surgery.

Aims: Colorectal cancer is the third most common cancer in European populations. It has been shown previously that neutrophil-lymphocyte ratio (NLR), pre-operative albumin, and haemoglobin are useful prognostic indicators. The aim of this study was to assess how these factors influence the length of postoperative stay (LOS) following colorectal cancer surgery. Methodology: All patients undergoing elective colorectal resections for malignancy between 2010 and 2011 in Pilgrim Hospital, Boston, U.K. were considered for the study. Hospital archive systems were used to ascertain pre-operative NLR, albumin and haemoglobin levels. LOS was calculated from electronic discharge documents with day 1 being the day after surgery. Unifactorial and multifactorial analyses were performed to identify independent predictors of prolonged stay. Results: 196 patients were included in the study. Pre-operative haemoglobin was not associated with prolonged hospital stay. On univariate analysis, pre-operative serum albumin and pre-operative NLR were associated with prolonged hospital stay. On multivariate analysis, pre-operative serum albumin >34.5 g/dl (odds ratio, 0.47; 95% confidence interval, 0.24 – 0.92; p = 0.027) retained independent association for prolonged hospital stay .However, pre-operative NLR failed to reach statistical significance on multivariate analysis. Conclusions: Patients with low albumin and elevated NLR are more likely to have an increased hospital stay following colorectal cancer surgery. This may be useful for surgeons in terms of identifying the ‘high-risk’ patient post-operatively and allow for early intervention.