Delphi consensus on intraoperative technical/surgical aspects to prevent surgical site infection after colorectal surgery

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ORIGINAL SCIENTIFIC ARTICLES FROM THE ACS SCIENTIFIC FORUM 2021 Delphi Consensus on Intraoperative Technical/Surgical Aspects to Prevent Surgical Site Infection after Colorectal Surgery Ruiz-Tovar, Jaime MD, PhD; Boermeester, Marja A MD, PhD; Bordeianou, Liliana MD, FACS, FASCRS; Chang, George J MD, MS, FACS, FASCRS, FSSO; Gorgun, Emre MD, FACS, FASCRS; Justinger, Christoph MD; Lawson, Elise H MD, MSHS, FACS; Leaper, David J DSC, MD, CHM, FRCS, FACS, FL; Mahmoud, Najjia N MD, FACS, FASCRS; Mantyh, Christopher MD, FACS, FASCRS; McGee, Michael F MD, FACS, FASCRS; Nfonsam, Valentine MD, MS, FACS, FASCRS; Rubio-Perez, Ines MD, PhD; Wick, Elizabeth C. MD, FACS; Hedrick, Traci L MD, MS, FACS, FACRS Collaborators Author Information Journal of the American College of Surgeons 234(1):p 1-11, January 2022. | DOI: 10.1097/XCS.0000000000000022 OPEN SDC INFOGRAPHIC

Metrics Abstract In Brief BACKGROUND: Previous studies have focused on the development and evaluation of care bundles to reduce the risk of surgical site infection (SSI) throughout the perioperative period. A focused examination of the technical/surgical aspects of SSI reduction during CRS has not been conducted. This study aimed to develop an expert consensus on intraoperative technical/surgical aspects of SSI prevention by the surgical team during colorectal surgery (CRS).

STUDY DESIGN: In a modified Delphi process, a panel of 15 colorectal surgeons developed a consensus on intraoperative technical/surgical aspects of SSI prevention undertaken by surgical personnel during CRS using information from a targeted literature review and expert opinion. Consensus was developed with up to three rounds per topic, with a prespecified threshold of ≥70% agreement.

RESULTS: In 3 Delphi rounds, the 15 panelists achieved consensus on 16 evidence-based statements. The consensus panel supported the use of wound protectors/retractors, sterile incision closure tray, preclosure glove change, and antimicrobial sutures in reducing SSI along with wound irrigation with aqueous iodine and closed-incision negative pressure wound therapy in high-risk, contaminated wounds.

CONCLUSIONS: Using a modified Delphi method, consensus has been achieved on a tailored set of recommendations on technical/surgical aspects that should be considered by surgical personnel during CRS to reduce the risk of SSI, particularly in areas where the evidence base is controversial or lacking. This document forms the basis for ongoing evidence for the topics discussed in this article or new topics based on newly emerging technologies in CRS.