Surgical trainee-led trial studies new dressings to reduce infection after open abdominal surgery

A trial supported by Birmingham Clinical Trials Unit explores methods to reduce post-operative surgical site infections.

Surgical instruments in the foreground, with two operating surgeons examining a patient in the background.

Laparotomies, or exploratory abdominal operations, are essential procedures central to the treatment of diseases such as cancer and trauma. Patients undergoing emergency laparotomy are at high risk of surgical site infections (SSIs), also called wound infections, which lead to longer healing times, longer hospital admissions, and poorer recovery, often with a significant psychological impact.

A surgical trainee-led team from Birmingham Clinical Trials Unit (BCTU) conducted a trial investigating the use of incisional negative pressure wound therapy (iNPWT) to reduce SSIs for adults following an emergency laparotomy. The trial was opened in the UK and Australia (in collaboration with the University of Newcastle, Australia), with 840 patients recruited from 22 hospitals in the UK and 12 in Australia. The trial was funded by the National Institute for Health and Care Research (NIHR)’s Research for Patient Benefit Programme and the Medical Research Future Fund (MRFF) in Australia.

The iNPWT approach involved using a small, battery-powered suction pump that delivered a negative pressure field to the dressing on the wound. Patients were randomised into two groups, one receiving the iNPWT and the other receiving their surgeon’s choice of wound dressing following their laparotomy operation.

The primary outcome was to evaluate the rate of SSI in both groups up to 30 days after surgery, which showed no significant difference between the use of the surgeon’s choice of dressing and the iNPWT. There were secondary outcomes also measured, some of which included length of hospital stay, wound pain, and quality of life post-surgery.

Out of these secondary outcomes, most outcomes showed consistency between the two groups, though participants in the iNPWT group reported lower pain levels a week after the procedure compared to the other group.

This was the first trial to be led by two trainee networks: The West Midlands Research Collaborative and North West Research Collaborative, and also the first to be delivered in conjunction with an international surgical network. It was the fourth surgical trainee-led trial to have been supported by the University of Birmingham, after the ROSSINI, DREAMS and ROCSS trials.

The full paper has been published in the Journal of the American Medical Association (JAMA), which can be accessed here:  https://jamanetwork.com/journals/jama/newonline