A randomised trial in this week’s issue of THE LANCET shows how postoperative wound infection could be substantially reduced if patients are given localised or systemic warming before undergoing surgery.
Wound infection after clean surgery (uninfected, operative surgery, where no inflammation is encountered and the respiratory, alimentary, and genitourinary tracts are not opened) is an expensive and underestimated cause of patient illness. The benefits of using prophylactic antibiotics in this type of surgery have not been proven. Warming patients during colorectal surgery has previously been shown to reduce infection rates. Andrew Melling and colleagues from the University Hospital of North Tees, Stockton-on-Tees, UK, assessed whether warming patients before short duration, clean surgery would have the same effect.
421 patients having clean (breast, varicose vein, or hernia) surgery were randomly assigned to either a non-warmed (standard) group or one of two warmed groups (local and systemic). Warming was applied at least 30 minutes before surgery. Patients were followed up at two and six weeks after surgery.
The investigators identified 19 wound infections in 139 non-warmed patients (14%) compared with 13 in 277 who received warming (5%). Patients not given warming were prescribed substantially more postoperative antibiotics
Andrew Melling comments: “The surgical episode and the first few hours afterwards have been widely accepted as the key period when a wound infection is likely to become established. Our study suggests that the hour before surgery may be just as important. The simple addition of two different types of warming, applied for at least 30 minutes before surgery, have both clearly reduced infection rates and therefore the need for additional treatment, including postoperative antibiotics. Preoperative warming may be an alternative to the controversial use of prophylactic antibiotics, that avoids the associated risks of allergy and resistance, in clean surgery.”
Contact: Mr Andrew C Melling, Professorial Unit of Surgery, North Tees & Hartlepool NHS Trust, University Hospital of North Tees, Hardwick, Stockton-On-Tees, TS19 8PE, UK; T) +44 (0)1642 624087 F) +44 (0)1642 624165; E) AndyMelling@Compuserve.com
Journal
The Lancet