Use of the Ring Wound Protector in Open Appendectomy: A Model-Based Cost-Utility Analysis

Objective: To evaluate cost-effectiveness of ring wound protector (RWP) used in open appendectomy. Materials and Methods: The present study was a decision-tree-based analysis. Model inputs, including costs, utilities, and probabilities of surgical site infection (SSI), were retrieved from the previous studies. The incremental cost-effectiveness ratio (ICER) represented the cost of one additional quality-adjusted life day (QALD). This ratio was calculated by dividing the incremental cost [Thai Baht (THB)] by the incremental QALD. One-way sensitivity analyses were performed by varying each input parameter to see how ICER change. Monte-Carlo simulation with 5,000 replications was used to estimate probabilistic ICER and construct the acceptability curve, demonstrating how the probability of being cost-effective changed when the willingness-to-pay (WTP) threshold was shifted. Results: The deterministic ICER of 64,630.78 THB/QALD did not favor RWP use compared with the WTP threshold of 10,000 THB/QALD. However, if the threshold was shifted to 100,000 THB/QALD, it would yield approximately 75% probability of being cost-effective from RWP. Threshold analysis indicated that RWP should cost 281, 301, and 661 THB to be cost-effective at the threshold of 500, 1,000, and 10,000 THB/QALD, respectively. Conclusion: Routine RWP use might not be cost-effective when QALD is the outcome of interest. Based on the results from the present study, policy-makers could be informed that the adoption of this health technology might not be suitable. Keywords: Ring wound protector; Appendectomy; Cost-utility analysis; Decision tree model

Prophylaxis of infection in region of the surgical intervention performance in laparoscopic cholecystectomy

Objective. To estimate the efficacy of prophylactic method for regional infection while performance of laparoscopic cholecystectomy, using simultaneous application of container for removal of the specimen and a two-ring wound protector of the wound. In accordance to the literature data, the infection rate in laparoscopic cholecystectomy conduction constitutes 2.4 - 9.6%. Materials and methods. The work was based on experience of performance of 759 laparoscopic cholecystectomies during the period of 2015 - 2018 yrs. There were performed 679 operations with the second class of microbial contamination, 17 - with the third one and 6 - with the fourth. In 21 patients the conversion into laparotomy was applied. The patients with third and fourth classes of microbial contamination of wounds were divided into two groups: the first - 61 patients, in whom a container was used for the specimen removal, and the second - 19 patients, in whom the method of combined application of container and the wound protector was applied for removal of the specimen. Results. Infection of region of the surgical intervention performance in laparoscopic cholecystectomy was revealed in 41 (5.40%) of 759 patients.In surgical interventions In surgical interventions, referring to second class of microbial contamination , the infection rate in the surgical intervention region have constituted 2,5%, while referring to the third class - 11.76%, and the fourth class - 34.92%. Conversion in laparoscopic cholecystectomy is accompanied with high rate of the wound infection - 38.09%. Conclusion. Application of the method of combined usage of container for removal of preparation and a two-ring protector of the wound in the third and the fourth classes of the wounds while performance of laparoscopic cholecystectomy have permitted to lower the infection rate in region of the surgical intervention performance from 37.70 to 5.26%.

USE OF WOUND PROTECTOR FOR PREVENTION OF SURGICAL SITE INFECTION IN LAPAROSCOPIC CHOLECYSTECTOMY

The work is based on the experience of 759 cholecystectomies performed in 2015-2018. Patients with a 3-4 grades of microbial contamination of wounds were divided into two groups: the first, with removal of the gallbladder traditionally with specimen retrieval container and the second, where proposed method of combined use of container and wound protector was used − 19 patients.Surgical site infection in laparoscopic cholecystectomy was detected in 5.40% (41 patients out of 759). During surgical interventions related to the second grade of microbial contamination (clean-contaminated), the frequency of SSI was 2.50%, to the third grade (contaminated) − 11.76%, and to the fourth grade (dirty) − 34.92%. Using the proposed method for the simultaneous use of the retrieval container and the double-ring wound protector in the second and third grades of wounds in LC allowed to reduce the frequency of SSI from 37.70% to 5.26%.

Circular pOlyethylene drape in preVEntion of suRgical site infection (COVER trial): study protocol for a randomised controlled trial

IntroductionSurgical site infection (SSI) after abdominal surgery remains a significant cause of morbidity and is associated with an increased socioeconomic burden and a reduced quality of life. Circular wound protectors have been expected to reduce the risk of SSI, but previous studies reported conflicting results on their protective effects. The purpose of this study was to evaluate the efficacy of circular wound protectors in reducing SSI in open abdominal surgery.Methods and analysisThe circular pOlyethylen drape in preVEntion of suRgical site infection (COVER) trial investigates whether the application of a dual-ring circular plastic wound protector reduces the rate of SSI in patients undergoing elective or emergent open abdominal surgery related to the gastrointestinal tract, regardless of the type of wound classified by the Centers for Disease Control. The COVER trial is a multicentre, randomised controlled clinical trial with two parallel arms—one using a dual-ring wound protector with circular polyethylene drape and the other using conventional surgical dressing gauze. The primary outcome will measure the rate of SSI within 30 days after surgery in two groups. Statistical analysis of the primary end point will be based on the intention-to-treat population. The sample size was determined to achieve a study power of 80% with 95% two-sided confidence limits. Considering a dropout rate of up to 5%, a total of 458 patients, 229 patients in each group, will be enrolled in this study.Ethics and disseminationThe trial protocol and informed consent document have been reviewed and approved by the institutional review board at each participating centre. Written informed consent will be obtained from each study participant. The clinical outcomes of this trial will be submitted to an international peer-reviewed journal and presented at international conferences.Trial registration numberNCT 03170843.