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

Sara Torfs (UGent) , Tamara Levet (UGent) , Catherine Delesalle (UGent) , Jeroen Dewulf (UGent) , Lieven Vlaminck (UGent) , Frederik Pille (UGent) , Laurence Lefère (UGent) and Ann Martens (UGent)
(2010) VETERINARY SURGERY. 39(5). p.616-620
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Abstract
Objective: To assess risk factors for celiotomy incisional infection in horses, especially the use of staples for skin closure. Study Design: Case series. Animals: Horses (n = 356) that had 1exploratory celiotomy for colic and survived > 2 weeks after surgery between March 1, 2004 and December 31, 2007. Methods; Incisions were classified as “normal” (no complication, only edema, serous drainage lasting < 24 hours) or as “surgical site infection (SSI)” (persistent serosanguinous drainage or purulent drainage with or without positive bacterial culture). All possible risk factors, including method of skin closure (monofilament sutures or staples), were statistically analyzed using univariate and multivariate logistic regression. Results: Of 356 horses, 303 (85%) had normal wound healing and 53 (15%) developed a SSI (purulent: 48 [14%]; persistent serosanguinous: 5 [1%]). Bacterial cultures were positive in 33 of 40 cases. Factors significantly associated with SSI in the multivariate analysis were: use of staples for skin closure (OR 3.85, P < .001) and surgical site closure by a 1st or 2nd year resident (OR 2.20, P = .016). Lavage of the linea alba with sterile saline solution after closure was a protective factor (OR 0.38, P = .004). Conclusion: Use of staples for skin closure and less experienced surgeons closing the abdomen are risk factors for incisional infection. Incisional lavage after linea alba closure was a protective factor. Clinical Relevance: Despite their ease and speed of application, skin staples can lead to an increase in celiotomy wound complications in horses.
Keywords
wound infection, staples, celiotomy, horse, colic, SUTURE, LAPAROTOMY, CESAREAN-SECTION, SURGICAL SITE INFECTION, risk factor analysis, SURGERY, CLOSURE, RATES

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MLA
Torfs, Sara et al. “Risk Factors for Incisional Complications After Exploratory Celiotomy in Horses: Do Skin Staples Increase the Risk?” VETERINARY SURGERY 39.5 (2010): 616–620. Print.
APA
Torfs, S., Levet, T., Delesalle, C., Dewulf, J., Vlaminck, L., Pille, F., Lefère, L., et al. (2010). Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk? VETERINARY SURGERY, 39(5), 616–620.
Chicago author-date
Torfs, Sara, Tamara Levet, Catherine Delesalle, Jeroen Dewulf, Lieven Vlaminck, Frederik Pille, Laurence Lefère, and Ann Martens. 2010. “Risk Factors for Incisional Complications After Exploratory Celiotomy in Horses: Do Skin Staples Increase the Risk?” Veterinary Surgery 39 (5): 616–620.
Chicago author-date (all authors)
Torfs, Sara, Tamara Levet, Catherine Delesalle, Jeroen Dewulf, Lieven Vlaminck, Frederik Pille, Laurence Lefère, and Ann Martens. 2010. “Risk Factors for Incisional Complications After Exploratory Celiotomy in Horses: Do Skin Staples Increase the Risk?” Veterinary Surgery 39 (5): 616–620.
Vancouver
1.
Torfs S, Levet T, Delesalle C, Dewulf J, Vlaminck L, Pille F, et al. Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk? VETERINARY SURGERY. 2010;39(5):616–20.
IEEE
[1]
S. Torfs et al., “Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk?,” VETERINARY SURGERY, vol. 39, no. 5, pp. 616–620, 2010.
@article{883817,
  abstract     = {Objective: To assess risk factors for celiotomy incisional infection in horses, especially the use of staples for skin closure.
Study Design: Case series.
Animals: Horses (n = 356) that had 1exploratory celiotomy for colic and survived > 2 weeks after surgery between March 1, 2004 and December 31, 2007.
Methods; Incisions were classified as “normal” (no complication, only edema, serous drainage lasting < 24 hours) or as “surgical site infection (SSI)” (persistent serosanguinous drainage or purulent drainage with or without positive bacterial culture). All possible risk factors, including method of skin closure (monofilament sutures or staples), were statistically analyzed using univariate and multivariate logistic regression.
Results: Of 356 horses, 303 (85%) had normal wound healing and 53 (15%) developed a SSI (purulent: 48 [14%]; persistent serosanguinous: 5 [1%]). Bacterial cultures were positive in 33 of 40 cases. Factors significantly associated with SSI in the multivariate analysis were: use of staples for skin closure (OR 3.85, P < .001) and surgical site closure by a 1st or 2nd year resident (OR 2.20, P = .016). Lavage of the linea alba with sterile saline solution after closure was a protective factor (OR 0.38, P = .004). 
Conclusion: Use of staples for skin closure and less experienced surgeons closing the abdomen are risk factors for incisional infection. Incisional lavage after linea alba closure was a protective factor.
Clinical Relevance: Despite their ease and speed of application, skin staples can lead to an increase in celiotomy wound complications in horses.},
  author       = {Torfs, Sara and Levet, Tamara and Delesalle, Catherine and Dewulf, Jeroen and Vlaminck, Lieven and Pille, Frederik and Lefère, Laurence and Martens, Ann},
  issn         = {0161-3499},
  journal      = {VETERINARY SURGERY},
  keywords     = {wound infection,staples,celiotomy,horse,colic,SUTURE,LAPAROTOMY,CESAREAN-SECTION,SURGICAL SITE INFECTION,risk factor analysis,SURGERY,CLOSURE,RATES},
  language     = {eng},
  number       = {5},
  pages        = {616--620},
  title        = {Risk factors for incisional complications after exploratory celiotomy in horses: do skin staples increase the risk?},
  url          = {http://dx.doi.org/10.1111/j.1532-950X.2009.00636.x},
  volume       = {39},
  year         = {2010},
}
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