A Novel Wound Retractor with Continuous Antibiotic Irrigation for Reducing Surgical Site Infection

Presented at
Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2022 Next Big Thing Session, 2022. Denver, CO.

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Yosef Nasseri, Kimberly Oka, Eli Kasheri, Ruoyan Zhu, Abbas Smiley, Jason Cohen, Joshua Ellenhorn, Moshe Barnajian

Background
The Alexis wound retractor has shown to be effective in reducing surgical site infections (SSI) in colorectal surgery. CleanCision is a novel wound retractor with continuous antibiotic irrigation.

Objective
Compare the effectiveness of the CleanCision and Alexis wound retractors in preventing SSIs
following colorectal resections.

Design/Settings/Patients
This single-arm clinical trial included patients undergoing colorectal resections utilizing the novel CleanCision retractor with continuous antibiotic irrigation. A retrospective cohort of patients undergoing the same procedures with the standard Alexis retractor was selected as the control group. The primary outcome assessed was SSI. Secondary outcomes assessed were overall complications, hospital length of stay (LOS), and 30-day readmission. A univariable and
multivariable logistic regression model was built to evaluate the association between SSI as the outcome variable and the use of CleanCision as the main independent variable. The model was adjusted for any confounding variables.

Results
100 CleanCision and 170 Alexis cases were enrolled with a mean ages of 64.9 and 62.9 years, respectively. There were no significant differences between the two groups in demographics and preoperative comorbidities. There were also no significant differences in diagnosis, resection type, length of operation, estimated blood loss, surgical technique, and elective versus emergent status. CleanCision cases had a significantly larger mean length of incision (6.4 vs. 4.9 cm, p = 0.04).
SSI rates were significantly lower in the CleanCision group (1% vs. 9.4%, p = 0.006). There were no significant differences in Clavien-Dindo classification, hospital LOS, and 30-day readmission. Multivariable logistic regression with backward elimination showed that the use of CleanCision was significantly more protective against SSI by 91.3% compared to the use of Alexis.

Limitations
Patients were not randomized.

Conclusion
The novel CleanCision irrigating retractor is significantly more effective than the standard Alexis retractor in preventing SSIs following colorectal resection.

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