Evaluation of a stent dressing for anaesthetic recovery on surgical site
infection following emergency equine laparotomy: A Randomised controlled
trial
Abstract
Background: Surgical site infection (SSI) is a frequent complication
following emergency equine laparotomy. It negatively impacts equine
welfare, increases treatment costs and is a hospital biosecurity risk
justifying investigations of ways to reduce SSI incidence. Objectives:
To determine if a sutured-on stent dressing for anaesthetic recovery
reduces SSI in horses following emergency laparotomy. Study design:
Randomised controlled trial. Methods: Eligible horses undergoing
emergency exploratory laparotomy were enrolled. Horses were randomised
to have a sutured-on stent dressing (intervention) or standard adhesive
textile dressing (control) placed for incisional protection during
anaesthetic recovery. Horses were followed up to 90 days
postoperatively. Data were analysed according to intention-to-treat
principles. Time to SSI (primary outcome) for each group was analysed
using a Cox proportional hazard model. Secondary outcomes (SSI during
hospitalisation, pyrexia during hospitalisation, days hospitalisation
and incisional hernia formation at 90 days) were analysed using
Chi-squared tests and a univariable logistic regression model
(categorical data) or by comparing means between groups (continuous
data). Results: The study included 352 horses (167 intervention group,
185 control group). SSI developed in 101 horses (28.7%) at a mean of
9.7 days (SD 4.6 days). Rate of SSI was not significantly different
between intervention and control groups unadjusted (Hazard Ratio
[HR] 0.83, 95% CI 0.56 - 1.23, P=0.36) or adjusted for variables
significantly associated with rate of SSI (HR 0.88, 95% CI 0.59 –
1.30, P=0.51). There were no significant differences in secondary
outcomes between intervention and control groups. Main limitations: This
study was performed at a single centre and only evaluated incisional
protection for anaesthetic recovery. Conclusions: Use of a sutured-on
stent dressing for anaesthetic recovery did not reduce the rate of SSI
compared to a textile adhesive dressing. Further RCT are required to
investigate efficacy of other interventions on reduction of SSI
following emergency laparotomy