COMPARISON OF SURGICAL SITE INFECTIONS WITH PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN STERILE AND CLEAN OPERATIVE FIELDS
Alexander Liu*, David Morrell, Michael F. Reed, Eric Pauli
Surgery, Penn State Milton S. Hershey Medical Center, Harrisburg, PA
Background
Percutaneous endoscopic gastrostomy (PEG) placement is performed to provide durable enteral access. While the alimentary tract is not a sterile environment, the procedure is often done under sterile conditions to reduce the risk of infection. Such endeavors add time and expense to the procedure without altering the wound class. The objective of this study is to compare surgical site infection (SSI) rates associated with PEG placement in sterile and clean operative fields.
Methods
An institutional review board approved retrospective evaluation was performed of adult patients who underwent PEG placement by two surgeons from March 2010 to July 2019. Both surgeons utilized pull PEG and chlorhexidine skin prep. Surgeon A typically performed PEG under clean technique (skin preparation without the use of drapes, non-sterile gloves, gown or mask). Surgeon B typically performed PEG under sterile technique (skin prep and drapes, sterile gloves, sterile gown and mask). All patients underwent routine post-PEG care and monitoring. Complications were extracted from the electronic medical record. Criteria for SSI included the use of antibiotic treatment or surgical debridement after diagnosis. Overall complications including bleeding, dislodgement, reoperation, readmission, and death were also recorded. Patients were stratified based on sterile vs. clean and compared using two-sample t-tests and chi-squared tests.
Results
A total of 455 patients (mean age of 62 years, 56.9% male) met inclusion criteria (Table 1). 247 PEGs were performed under clean conditions with an overall SSI rate of 2.02%; 208 were placed in sterile operative fields with an SSI rate of 1.44% (p = 0.7320). The overall complication rate was 9.72% for clean PEGs and 15.4% for sterile PEGs. The breakdown of individual complications is shown in Table 1 with dislodgement being the most common for both groups (2.43% clean vs. 9.62% sterile, p = 0.0010). When comparing by surgeon cohort (Table 2), 242 clean PEGs performed by Surgeon A had a SSI rate of 2.07% while 190 sterile PEGs performed by Surgeon B had a SSI rate of 0.53% (p = 0.1747).
Conclusion
There is no difference in the rates of SSI associated with PEG placement utilizing a sterile or clean operative field. The use of drapes and equipment to form a sterile operative field may be unnecessary to limiting SSI. Given how common PEG is, there is potential for substantial cost savings without compromising safety. Further study is indicated.
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