Abdominal closure protocol in colorectal, gynecologic oncology, and urology procedures: a randomized quality improvement trial

• A closing tray used at fascial closure does not decrease surgical site infection.
• This study was a prospective randomized quality improvement trial.
• A total of 233 patients were randomized to the closing tray or usual care.

BackgroundPrevention of surgical site infections (SSIs) can improve surgical quality through reductions in morbidity and cost. We sought to determine whether the abdominal closure protocol, in isolation, decreases SSI at an academic teaching hospital.MethodsAdult patients undergoing laparotomy were prospectively randomized to an abdominal closure protocol, which includes unused sterile instruments and equipment at fascial closure, or usual care. A 30-day SSI rates were compared. General surgery, colorectal, urology, or gynecologic oncology patients undergoing anticipated wound classification II cases were eligible.ResultsOverall SSI rates were 11.6% in patients randomized to protocol closure vs 12.4% for usual care (total n = 233; P = .85). The abdominal closure protocol and usual care groups had similar rates of superficial (4.5% vs 4.1%; P = .9), deep (.9% vs 0%, P = .3), organ-space SSI rates (6.2% vs 8.3%, P = .55), and wound dehiscence (2.7% vs 5.3%; P = .24).ConclusionsAn abdominal closure protocol did not decrease the rate of SSI and is likely not a key intervention for SSI reduction.