The Effect Of Vacuum-Assisted Closure Drainage On Prevention Of The Incidence Of Surgery Site Infection In High-risk Colorectal Cancer Patients

BackgroundColorectal Cancer?CRC?is one of the most common causes of cancer and death in the world.The incidence of the disease is high in the world.The incidence and mortality of colorectal cancer is increasing gradually and up to 3^rd cancer.Surgical Site Infection?SSI?will prolong the hospitalization time of patients and increase the economic and mental burden of patients.Most CRC patients need adjuvant chemotherapy such as radiotherapy and chemotherapy,and the occurrence of SSI will affect the further therapy.SSI is one of the challenges that make surgeons confused worldwide.An economical and effective way to reduce the incidence of SSI is the key focus of clinical research.This article aims to verify whether VACD can reduce the SSI rate by comparing the infection rate between VACD group and non-VACD group.MethodsThe clinical parameter in colorectal cancer?CRC?patients who underwent colorectal surgery in Gastrointestinal Surgery,First Hospital of China Medical University from2013 to 2017 were retrospectively analyzed.The ROC curve was obtained by measuring thickness of subcutaneous fat?TSF?by preoperative CT.The Youden index was calculated to obtain the cutoff value of TSF is 2.27 cm.60 CRC patients with high risk for incisional SSI,?thick subcutaneous fat tissue,?2cm?were enrolled in this RCT study from July 2017 to May 2018.Patients were randomly divided into two groups,of which 28 patients were in the VACD group and the others 32 are in non-VACD group.The length of follow-up was 30 days after surgery.The wound healing was monitored until the incision healed completely.Comparing with the SSI rate of two groups,our study evaluates the efficacy and necessity of VACD in the prevention of SSI in high-risk patients after colorectal cancer surgery.ResultsThe overall SSI complication rate was 21.7%?13/60?,with 7.1%?2/28?among the group receiving a drain versus 34.4%?11/32?without a drain.VACD can significantly reduce incidence of SSI?p=0.013?.The average TSF of the patients with SSI is 2.66cm,the average TSF of the patients without SSI is 2.41cm,TSF is significantly associated with the incidence of SSI?p=0.043?,the other factors such as BMI,nutritive index,stoma and diabetes mellitus are not the key factor of the incidence of SSI.?p>0.05?ConclusionThe thickness of subcutaneous fat is the risk factor that significantly effect CRC patients wound healing.For CRC patients with TSF?2cm evaluated by preoperative CT,VACD can significantly reduce the incidence rate of SSI.