Negative Pressure Dressings to Prevent Surgical Site Infection After Emergency Laparotomy
SUNRRISE Trial Study Group, James Brown, H.W. Clouston, P Coe, Rui Duarte, Sarah Duff, Rebecca Fish, Paula Ghaneh, James Glasbey, Natalie Ives, Elisabeth Johnston, Manjinder Kaur, Laura Magill, Samir Mehta, Tom Pinkney, Kellie Platt, Peter Pockney, Hema Sekhar, Yash Sinha, Martyn Stott, Richard Wilkin, Hossein Haji Ali Afzali, K Almeida, Tom Arthur, Kristy Atherton, Kenneth Keen Yip Chew, Giuliana D'Aulerio, Amanda Dawson, Nagendra N. Dudi‐Venkata, N Egoroff, Tracy Fitzsimmons, Scott Gelzinnis, Maddie Gramlick, Naomi Knoblauch, Natalie Lott, Elizabeth Lun, Vijayaragavan Muralidharan, Kat Penna, Toby Richards, Georgina Riddiough, Suzanne Ryan, Tarik Sammour, S. L. Stanton, Bree Stephensen, Sean Stevens, Vo Pham Phuong Uyen, David Watson, Xuanyu Zhou, Neil Corrigan, Matthew L. Costa, Lesley Osborn, Marcos Gómez Ruiz, Jo C Dumville, Nigel R. Hall, Ly‐Mee Yu, Helen Bermingham, Mark Dilworth, Athanasia Filippa, Tabinda Kharodia, Dimitrios Stamatiou, Amy Barnett, A. M. Blackmore, Lorraine Hickey, Sarah Melling, Carl Podesta, Karen Hogben, Pamela Ng, A.J. Oglesby, Edel O'Neill, Yaamini Premakumar, Fahed Youssef, Ahmed Ahmed, Alex Boddy, Emma Bown, Jill Cooke, Tanvir Hossain, David Hunter, Farah Khasawneh, Rosie McDonald, Mohamed Mohamed, Chris J. Neal, Tom Palser, Tim Rattay, Hisham Zain Butt, Adel Abulkhir, Ziad Al-Khaddar, Khalid Amin, M Bogdan, M Bughio, Kayode Habeeb, Debra Jowle, Andrew Kennedy-Dalby, Usman Khan, Jennifer Reynolds, Mohammed Sadat, Samer Shami, Chris J Smart, Barbara Townley, Simon Ward, Helen Wassall
Abstract
Importance: Patients undergoing unplanned abdominal surgical procedures are at increased risk of surgical site infection (SSI). It is not known if incisional negative pressure wound therapy (iNPWT) can reduce SSI rates in this setting. Objective: To evaluate the effectiveness of iNPWT in reducing the rate of SSI in adults undergoing emergency laparotomy with primary skin closure. Design, Setting, and Participants: SUNRRISE was an assessor-masked, pragmatic, phase 3, individual-participant, randomized clinical trial. Adult patients undergoing emergency laparotomy in 22 hospitals in the UK and 12 hospitals in Australia between December 18, 2018, and May 25, 2021, were recruited. Patients were followed up for 30 days postprocedure; database closure was on August 25, 2021. Interventions: Participants were randomized 1:1 to receive iNPWT (n = 411), which involved a specialized dressing used to create negative pressure over the closed wound vs the surgeon's choice of wound dressing (n = 410). Randomization and dressing application occurred in the operating room at the end of the surgical procedure. Main Outcomes and Measures: The primary outcome measure was SSI up to 30 days postprocedure, evaluated by an assessor masked to the randomized allocation and using criteria from the US Centers for Disease Control and Prevention. There were 7 secondary outcomes, including length of hospital stay, postoperative complications up to 30 days, hospital readmission for wound-related complications within 30 days, wound pain, and quality of life. Results: A total of 840 patients were randomized (536 from the UK; 304 from Australia). Overall, 52% were female; the mean age was 63.8 (range, 18.8 to 95.3) years. After postrandomization exclusions (N = 52), 394 participants per group were included in the primary analysis. The number of participants who had an SSI in the iNPWT group was 112 of 394 (28.4%), compared with 108 of 394 (27.4%) in the surgeon's preference group (relative risk, 1.03 [95% CI, 0.83-1.28]; P = .78). This finding was consistent across the preplanned subgroup analyses, including degree of contamination, presence of a stoma, participant body mass index, and skin preparation used, and across all preplanned sensitivity analyses. Of 7 secondary outcomes, 6 showed no significant difference, including hospital readmission, quality of life, and hospital stay (median [IQR], 8 [6-14] days in the iNPWT group and 9 [6-14.5] days in the surgeon's preference group [ratio of geometric means, 0.96 (95% CI, 0.88-1.06); P = .21]). Conclusions and Relevance: Routine application of iNPWT to the closed surgical wound after emergency laparotomy did not prevent SSI more than other dressings. Trial Registration: isrctn.com Identifier: ISRCTN17599457; anzctr.org.au Identifier: ACTRN12619000496112.