EVALUATION OF SEVERITY AND FREQUENCY OF SURGICAL SITE INFECTIONS IN DELAYED PRIMARY CLOSURE VERSUS IMMEDIATE CLOSURE ON SUCTION DRAIN IN CONTAMINATED ABDOMINAL SURGERIES

Abstract

Background: Surgical site infection (SSI) remains one of the most frequent postoperative complications following contaminated abdominal surgery. Delayed primary closure (DPC) has traditionally been recommended to reduce SSI, whereas immediate closure over closed suction drainage (ICOSD) has emerged as a promising alternative by facilitating continuous drainage of contaminated subcutaneous collections while allowing early skin approximation. The objective is to compare the incidence and severity of surgical site infection, surgical site occurrences (SSO), and postoperative hospital stay between ICOSD and DPC in contaminated abdominal surgeries. Materials and Methods: This prospective observational study was conducted in the Department of General Surgery of a tertiary care teaching hospital in Eastern India over 18 months. Ninety-two adult patients with contaminated abdominal wounds undergoing exploratory laparotomy were included and allocated into two equal groups: ICOSD (n = 46) and DPC (n = 46). Baseline demographic and clinical characteristics were comparable between the groups. Patients were followed for 10 postoperative days, and SSI was classified according to the Centers for Disease Control and Prevention criteria. Primary outcome was SSI, while secondary outcomes included surgical site occurrences (excluding SSI) and duration of hospital stay. Results: Overall wound-related complications were significantly lower in the ICOSD group than in the DPC group (30.4% vs. 52.2%; p = 0.049). SSI occurred less frequently with ICOSD than with DPC (26.1% vs. 34.8%), although the difference was not statistically significant. Surgical site occurrences excluding SSI were significantly reduced with ICOSD (4.3% vs. 17.4%; p = 0.037). The distribution of superficial and deep SSI was similar in both groups (p = 1.00). Mean postoperative hospital stay was significantly shorter in the ICOSD group (12.04 ± 2.93 days) than in the DPC group (13.85 ± 3.00 days; p = 0.0045). Conclusion: ICOSD is a safe and effective alternative to DPC in contaminated abdominal surgery. Although the reduction in SSI did not reach statistical significance, ICOSD significantly decreased overall wound-related complications, reduced non-infectious surgical site occurrences, and shortened hospital stay. The technique represents a practical and resource-efficient strategy for improving postoperative wound outcomes in contaminated abdominal surgeries.