Prevalence and predictors of surgical site infections after bowel resection for Crohn’s disease: the role of dual-ring wound protector

  • Xiaolong Ge
  • Shasha Tang
  • Weilin Qi
  • Wei Liu
  • Jiemin Lv
  • Qian Cao
  • Wei ZhouEmail author
  • Xiujun Cai
Original Article



Surgical site infections (SSIs) have become a leading cause of preventable morbidity and mortality in surgery. The aim was to evaluate the efficacy of a dual-ring wound protector to prevent the SSIs in Crohn’s disease (CD) after bowel resection.


This retrospective observational study included all CD patients undergoing bowel resection at the Inflammatory Bowel Disease Center between January 2015 and June 2018 at Sir Run Run Shaw Hospital. Risk factors of SSIs were evaluated by assessing preoperative clinical characteristics and perioperative treatments in univariate and multivariate analyses. Outcomes for CD patients with and without the wound protector were compared.


Three hundred forty-four CD patients were enrolled in this study, 121 (35.2%) patients had postoperative complications, of whom, 72 (20.9%) patients developed SSIs (12.8% patients with incisional SSI and 8.1% patients with organ/space SSI). There was a significant reduction in the incidence of incisional SSI in the wound protector group (8.1% vs 16.8%, p < 0.05). No significant differences were identified in organ/space SSI between groups with and without wound protector (6.3% vs 9.8%, p = 0.232). Incisional SSI correlated with preoperative albumin, C-reactive protein, white blood cell, age (≤ 16), penetrating disease behavior, surgical history, open surgery, stoma creation, estimated blood loss, infliximab, and wound protector (p < 0.05). Multivariate analysis identified the wound protector to be one of independent factors for preventing incisional SSIs (OR 0.357, 95% CI 0.161–0.793, p < 0.05).


Among the CD patients with bowel resection, the use of a dual-ring wound protector during surgery significantly reduced the risk of incisional SSI.


Crohn’s disease Surgical site infection Wound protector Bowel resection 



The authors gratefully acknowledge all of the investigators for their contributions to the trial, as well as Bin Chen, who provided medical writing assistance.

Author’s contributions

Xiaolong Ge and Wei Zhou contributed to the study conception and design, Xiaolong Ge, Weilin Qi, and Shasha Tang contributed to the acquisition of data, Wei Liu and Jiemin Lv contributed to the analysis and interpretation of data, Xiaolong Ge and Shasha Tang contributed to the drafting of manuscript, and Qian Cao, Xiujun Cai, and Wei Zhou contributed to the critical revision.


Supported by grants from National Natural Science Foundation of China (81800474) and Zhejiang Natural Science Foundation (LY18H030006).

Compliance with ethical standards

The institutional review board of Sir Run Run Shaw Hospital approved the project.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L (2017) Crohn's disease. Lancet 389(10080):1741–1755. CrossRefGoogle Scholar
  2. 2.
    Liu W, Zhou W, Xiang J, Cao Q, Zhu J, Qi W, Chen P, Xie Q (2018) Lemann index at diagnosis predicts the risk of early surgery in Crohn’s disease. Dis Colon Rectum 61(2):207–213. CrossRefGoogle Scholar
  3. 3.
    Regueiro M, Schraut W, Baidoo L, Kip KE, Sepulveda AR, Pesci M, Harrison J, Plevy SE (2009) Infliximab prevents Crohn’s disease recurrence after ileal resection. Gastroenterology 136(2):441–450 e441; quiz 716. CrossRefGoogle Scholar
  4. 4.
    Shen B (2017) IBD: step-up vs top-down therapy for Crohn’s disease: medicine vs surgery. Nat Rev Gastroenterol Hepatol 14(12):693–695. CrossRefGoogle Scholar
  5. 5.
    Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A, Warusavitarne J, Buskens CJ, van Bodegraven AA, Brink MA, ECJ C, van Wagensveld BA, MCM R, Crolla R, Noomen CG, Houdijk APJ, Mallant RC, Boom M, Marsman WA, Stockmann HB, Mol B, de Groof AJ, Stokkers PC, D’Haens GRR, Bemelman WA, group LCs (2017) Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol 2(11):785–792. CrossRefGoogle Scholar
  6. 6.
    Fumery M, Seksik P, Auzolle C, Munoz-Bongrand N, Gornet JM, Boschetti G, Cotte E, Buisson A, Dubois A, Pariente B, Zerbib P, Chafai N, Stefanescu C, Panis Y, Marteau P, Pautrat K, Sabbagh C, Filippi J, Chevrier M, Houze P, Jouven X, Treton X, Allez M, investigators Rsg (2017) Postoperative complications after ileocecal resection in Crohn’s disease: a prospective study from the REMIND group. Am J Gastroenterol 112(2):337–345. CrossRefGoogle Scholar
  7. 7.
    Zuo L, Li Y, Wang H, Zhu W, Zhang W, Gong J, Li N, Li J (2015) A practical predictive index for intra-abdominal septic complications after primary anastomosis for Crohn’s disease: change in C-reactive protein level before surgery. Dis Colon Rectum 58(8):775–781. CrossRefGoogle Scholar
  8. 8.
    Uchino M, Ikeuchi H, Tsuchida T, Nakajima K, Tomita N, Takesue Y (2009) Surgical site infection following surgery for inflammatory bowel disease in patients with clean-contaminated wounds. World J Surg 33(5):1042–1048. CrossRefGoogle Scholar
  9. 9.
    Bhakta A, Tafen M, Glotzer O, Ata A, Chismark AD, Valerian BT, Stain SC, Lee EC (2016) Increased incidence of surgical site infection in IBD patients. Dis Colon Rectum 59(4):316–322. CrossRefGoogle Scholar
  10. 10.
    Weiss CA 3rd, Statz CL, Dahms RA, Remucal MJ, Dunn DL, Beilman GJ (1999) Six years of surgical wound infection surveillance at a tertiary care center: review of the microbiologic and epidemiological aspects of 20,007 wounds. Arch Surg 134(10):1041–1048CrossRefGoogle Scholar
  11. 11.
    Bressan AK, Aubin JM, Martel G, Dixon E, Bathe OF, Sutherland FR, Balaa F, Mimeault R, Edwards JP, Grondin SC, Isherwood S, Lillemoe KD, Saeed S, Ball CG (2018) Efficacy of a dual-ring wound protector for prevention of surgical site infections after pancreaticoduodenectomy in patients with intrabiliary stents: a randomized clinical trial. Ann Surg 268(1):35–40. CrossRefGoogle Scholar
  12. 12.
    Pinkney TD, Calvert M, Bartlett DC, Gheorghe A, Redman V, Dowswell G, Hawkins W, Mak T, Youssef H, Richardson C, Hornby S, Magill L, Haslop R, Wilson S, Morton D, West Midlands Research C, Investigators RT (2013) Impact of wound edge protection devices on surgical site infection after laparotomy: multicentre randomised controlled trial (ROSSINI trial). Bmj 347:f4305. CrossRefGoogle Scholar
  13. 13.
    Reid K, Pockney P, Draganic B, Smith SR (2010) Barrier wound protection decreases surgical site infection in open elective colorectal surgery: a randomized clinical trial. Dis Colon Rectum 53(10):1374–1380. CrossRefGoogle Scholar
  14. 14.
    Gheorghe A, Calvert M, Pinkney TD, Fletcher BR, Bartlett DC, Hawkins WJ, Mak T, Youssef H, Wilson S, West Midlands Research C, Group RTM (2012) Systematic review of the clinical effectiveness of wound-edge protection devices in reducing surgical site infection in patients undergoing open abdominal surgery. Ann Surg 255(6):1017–1029. CrossRefGoogle Scholar
  15. 15.
    Luo Y, Qiu YE, Mu YF, Qin SL, Qi Y, Zhong M, Yu MH, Ma LY (2017) Plastic wound protectors decreased surgical site infections following laparoscopic-assisted colectomy for colorectal cancer: a retrospective cohort study. Medicine 96(37):e7752. CrossRefGoogle Scholar
  16. 16.
    Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, Abbas M, Atema JJ, Gans S, van Rijen M, Boermeester MA, Egger M, Kluytmans J, Pittet D, Solomkin JS, Group WHOGD (2016) New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 16(12):e276–e287. CrossRefGoogle Scholar
  17. 17.
    Hedrick TL, Harrigan AM, Sawyer RG, Turrentine FE, Stukenborg GJ, Umapathi BA, Friel CM (2015) Defining surgical site infection in colorectal surgery: an objective analysis using serial photographic documentation. Dis Colon Rectum 58(11):1070–1077. CrossRefGoogle Scholar
  18. 18.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  19. 19.
    Ge X, Dai X, Ding C, Tian H, Yang J, Gong J, Zhu W, Li N, Li J (2017) Early postoperative decrease of serum albumin predicts surgical outcome in patients undergoing colorectal resection. Dis Colon Rectum 60(3):326–334. Google Scholar
  20. 20.
    Satsangi J, Silverberg MS, Vermeire S, Colombel JF (2006) The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 55(6):749–753. CrossRefGoogle Scholar
  21. 21.
    Maeda K, Nagahara H, Shibutani M, Otani H, Sakurai K, Toyokawa T, Tanaka H, Kubo N, Muguruma K, Kamata N, Yamagami H, Hirakawa K (2015) A preoperative low nutritional prognostic index correlates with the incidence of incisional surgical site infections after bowel resection in patients with Crohn’s disease. Surg Today 45(11):1366–1372. CrossRefGoogle Scholar
  22. 22.
    Krizek TJ, Robson MC (1975) Evolution of quantitative bacteriology in wound management. Am J Surg 130(5):579–584CrossRefGoogle Scholar
  23. 23.
    Mohan HM, Mcdermott S, Fenelon L, Fearon NM, O’Connell PR, Oon SF, Burke J, Keane E, Shields C, Winter DC, Members of the University College Dublin Wound Retractor Study G (2012) Plastic wound retractors as bacteriological barriers in gastrointestinal surgery: a prospective multi-institutional trial. J Hosp Infect 81(2):109–113. CrossRefGoogle Scholar
  24. 24.
    Horiuchi T, Tanishima H, Tamagawa K, Sakaguchi S, Shono Y, Tsubakihara H, Tabuse K, Kinoshita Y (2010) A wound protector shields incision sites from bacterial invasion. Surg Infect 11(6):501–503. CrossRefGoogle Scholar
  25. 25.
    Gabrielsen J, Petrick A, Ibele A, Wood GC, Benotti P (2014) A novel technique for wound protector deployment and efficient specimen extraction following laparoscopic sleeve gastrectomy. J Gastrointest Surg 18(9):1678–1682. CrossRefGoogle Scholar
  26. 26.
    Uchino M, Ikeuchi H, Bando T, Chohno T, Sasaki H, Horio Y, Nakajima K, Takesue Y (2017) Efficacy of preoperative oral antibiotic prophylaxis for the prevention of surgical site infections in patients with Crohn disease: a randomized controlled trial. Ann Surg 269:420–426. CrossRefGoogle Scholar
  27. 27.
    Uchino M, Ikeuchi H, Matsuoka H, Bando T, Ichiki K, Nakajima K, Tomita N, Takesue Y (2013) Risk factors for surgical site infection and association with infliximab administration during surgery for Crohn’s disease. Dis Colon Rectum 56(10):1156–1165. CrossRefGoogle Scholar
  28. 28.
    Lightner AL, Mathis KL, Tse CS, Pemberton JH, Shen B, Kochlar G, Singh A, Dulai PS, Eisenstein S, Sandborn WJ, Parry L, Stringfield S, Hudesman D, Remzi F, Loftus EV Jr (2018) Postoperative outcomes in vedolizumab-treated patients undergoing major abdominal operations for inflammatory bowel disease: retrospective multicenter cohort study. Inflamm Bowel Dis 24(4):871–876. CrossRefGoogle Scholar
  29. 29.
    Brouquet A, Maggiori L, Zerbib P, Lefevre JH, Denost Q, Germain A, Cotte E, Beyer-Berjot L, Munoz-Bongrand N, Desfourneaux V, Rahili A, Duffas JP, Pautrat K, Denet C, Bridoux V, Meurette G, Faucheron JL, Loriau J, Guillon F, Vicaut E, Benoist S, Panis Y, group Gc (2018) Anti-TNF therapy is associated with an increased risk of postoperative morbidity after surgery for ileocolonic Crohn disease: results of a prospective nationwide cohort. Ann Surg 267(2):221–228. CrossRefGoogle Scholar
  30. 30.
    Wilson MZ, Connelly TM, Hollenbeak CS, Messaris E (2014) Organ space infection following ileocolectomy for Crohn’s disease: a National Surgical Quality Improvement Project study. Am J Surg 208(5):749–755. CrossRefGoogle Scholar
  31. 31.
    Serradori T, Germain A, Scherrer ML, Ayav C, Perez M, Romain B, Palot JP, Rohr S, Peyrin-Biroulet L, Bresler L (2013) The effect of immune therapy on surgical site infection following Crohn’s disease resection. Br J Surg 100(8):1089–1093. CrossRefGoogle Scholar
  32. 32.
    Ikeshima R, Mizushima T, Takahashi H, Haraguchi N, Nishimura J, Hata T, Matsuda C, Ikenaga M, Nakajima K, Yamamoto H, Murata K, Doki Y, Mori M (2018) The efficacy of active drainage for preventing postoperative organ/space surgical site infections in patients with Crohn’s disease. Surg Today 48(1):25–32. CrossRefGoogle Scholar
  33. 33.
    Patel KV, Darakhshan AA, Griffin N, Williams AB, Sanderson JD, Irving PM (2016) Patient optimization for surgery relating to Crohn’s disease. Nat Rev Gastroenterol Hepatol 13(12):707–719. CrossRefGoogle Scholar
  34. 34.
    Levy SM, Holzmann-Pazgal G, Lally KP, Davis K, Kao LS, Tsao K (2013) Quality check of a quality measure: surgical wound classification discrepancies impact risk-stratified surgical site infection rates in pediatric appendicitis. J Am Coll Surg 217(6):969–973. CrossRefGoogle Scholar
  35. 35.
    Cosnes J, Bourrier A, Nion-Larmurier I, Sokol H, Beaugerie L, Seksik P (2012) Factors affecting outcomes in Crohn’s disease over 15 years. Gut 61(8):1140–1145. CrossRefGoogle Scholar
  36. 36.
    Romy S, Eisenring MC, Bettschart V, Petignat C, Francioli P, Troillet N (2008) Laparoscope use and surgical site infections in digestive surgery. Ann Surg 247(4):627–632. CrossRefGoogle Scholar
  37. 37.
    Drosdeck J, Harzman A, Suzo A, Arnold M, Abdel-Rasoul M, Husain S (2013) Multivariate analysis of risk factors for surgical site infection after laparoscopic colorectal surgery. Surg Endosc 27(12):4574–4580. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General Surgery, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouChina
  2. 2.Inflammatory Bowel Disease Center, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouChina
  3. 3.Department of Gastroenterology, Sir Run Run Shaw Hospital, School of MedicineZhejiang UniversityHangzhouChina

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