Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk?

This research paper analyzes risk factors associated with incisional infection in horses post-celiotomy (abdominal surgery), particularly noting the correlation of using staples for skin closure. The findings suggest that using staples and having less experienced surgeons increase the risk of infection, while lavaging the incisional area post surgery serves as a protective measure.

Methods

• The study is based on a case series methodology, involving 356 horses that had one-exploratory celiotomy for colic and survived more than two weeks post surgery between March 1, 2004, and December 31, 2007.
• The incisions were categorized as “normal” (no complication, only edema or serous drainage lasting less than 24 hours) or “surgical site infection (SSI)” (persistent serosanguinous drainage or purulent drainage with or without positive bacterial culture).
• All potential risk factors including the use of either monofilament sutures or staples for skin closure were statistically analyzed utilizing both univariate and multivariate logistic regression.

Results

• Of the 356 horses analyzed, 303 (85%) showed normal wound healing, while 53 (15%) developed a SSI. Among the horses with SSI, bacterial cultures were found to be positive in 33 of the 40 cases.
• Through multivariate analysis, it was found that factors significantly associated with SSI were the use of staples for skin closure (having an odds ratio [OR] 3.85) and surgical site closure being performed by a first or second year resident (OR 2.20).
• Interestingly, the act of lavaging the linea alba with sterile saline solution post closure was identified as a protective factor against SSI, with an odds ratio of 0.38.

Conclusions

• The research concludes that the use of staples for skin closure post-celiotomy increases the chance of incisional infections in horses. The proficiency level of surgeons also surfaced as a risk factor, with first or second year residents presenting a higher incidence of infections in surgeries they closed.
• On the flip side, lavaging the linea alba (a fibrous structure in the lower abdomen) with sterile saline solution after closing it was found to be a protective factor against incisional infection.
• Despite the ease and quickness of applying skin staples, the study results indicate their use can lead to an increase in post-celiotomy wound complications in horses. This is a critical point to consider in veterinary surgical practices.