Skin Closure after Laparotomy: A National Survey of Surgeon Risk Assessment and Management

Author(s):
Chelsea Guy-Frank; Heather Kregel; Shah-Jahan Dodwad; Kayla Isbell; Gabrielle Hatton; Luciano Posada; Hannah Ortiz; Charles Wade; Jonah Stulberg; John Harvin; Lillian Kao

Background:

Emergent trauma laparotomies (TL) are high risk for postoperative complications. Wound management, though considered universally important, is varied in clinical practice. We evaluated surgeon decision making of skin management strategies and risk assessments for superficial-surgical site infection (S-SSI) after TL.

Hypothesis:

We hypothesize that most surgeons will close the skin on low-risk patients and there will be more variation in management as S-SSI risk increases.

Methods:

An anonymous survey was distributed to the Surgical Infection Society (SIS) of 8 fictional TL scenarios with a wide range of S-SSI risk. Risk was calculator-generated, based off an intraoperative, point-of-care Bayesian risk calculator. Surgeon participants were randomized by Qualtrics Software to 4 scenarios. Data was analyzed for trends in surgeon generated infection risk estimation and wound management based on groupings of S-SSI risk: low, medium, high.

Results:

Twenty-nine surgeons started the survey, with 22 completing >95%. Sixty-four percent were male; 45% were 41-50 years old; 95% are practicing as attendings, and 90% work in an academic setting. Eighty-one percent identified as trauma surgeons, and 85% had >5 years of experience. In the risk calculator generated groups, the percentage of surgeons who would close the skin decreased with increasing S-SSI risk: low: 79% closed skin, moderate: 62% closed skin, high: 52% closed skin. Surgeon estimated S-SSI risk varied, with ~50% agreeing with the risk-calculated S-SSI groupings.

Conclusions:

The early findings of this study indicate that estimates of S-SSI risk vary between surgeons and with those of a single-center derived point-of-care risk calculator. The percentage of surgeons who would close the skin decreased based on both calculator-informed and surgeon-derived estimates of S-SSI risk. Having a standardized estimator of S-SSI risk may help to guide surgeon decision-making.