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

ABSTRACT

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 for perforated appendix, perforated duodenal ulcer and ileal perforation. This quasi-experimental study was carried out at Surgical Unit I at Benazir Bhutto Hospital from January 2011 to December 2011. Patients undergoing contaminated abdominal surgery including perforated 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. 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 for surgery. SSI was diagnosed in 19.8% patients. 30.2% in the PC group and 9.3% in the DPC group developed SSI. Hence significantly greater proportion of PC group patients developed SSI as compared to DPC patients; p=0.015. The severity if infection [superficial, deep or organ space] was not significantly different between the PC and DPC groups; p= 0.378. Significantly greater wound dehiscence was encountered in PC group; p=0.011. There frequency of SSI was significantly lower after delayed primary closure of contaminated wounds as compared to primary closure