Evaluation of a stent dressing and abdominal bandage on surgical site infection following emergency equine laparotomy: A randomised controlled trial.
Authors: Isgren, Pinchbeck, Salem, Hann, Townsend, Cullen, Archer
Journal: Equine veterinary journal
Summary
# Editorial Summary Surgical site infection remains a stubborn problem in equine emergency abdominal surgery, compromising welfare outcomes and driving up hospitalisation costs, which prompted researchers to investigate whether a sutured-on stent dressing could offer better incisional protection than standard textile dressings during the vulnerable anaesthetic recovery period. In this multicentre randomised controlled trial, 352 horses undergoing emergency laparotomy were assigned to receive either a sutured stent as their primary wound layer (within a three-layer abdominal bandage) or a conventional textile dressing, with follow-up extending to 90 days postoperatively and statistical analysis following intention-to-treat principles. SSI developed in 101 horses overall (28.7%), but critically, the hazard ratio of 0.83 for the stent group compared with controls was not statistically significant, whether adjusted or unadjusted (p = 0.5), and secondary outcomes including pyrexia during hospitalisation, hospitalisation duration, and incisional hernia formation at 90 days showed no meaningful differences between groups. Although this represents a rigorous trial design, the single-centre setting and the specific combination of dressing layers used mean results may not fully translate to other protocols or facilities; clinicians should recognise that optimising SSI prevention likely requires interventions beyond primary dressing choice alone, such as improved antiseptic protocols or perioperative management strategies. Further well-designed trials investigating alternative approaches to reducing post-laparotomy infection are warranted, as the current findings suggest the profession needs to look beyond dressing materials to meaningfully impact this persistent complication.
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Practical Takeaways
- •Choice between sutured stent dressing and textile dressing for post-laparotomy abdominal bandaging does not impact surgical site infection rates in horses — use clinical preference and availability
- •Approximately 1 in 3.5 emergency laparotomy cases will develop SSI regardless of primary dressing type, indicating need for investigation of other prevention strategies
- •Current abdominal bandaging protocols (3-layer systems) may be insufficient alone to prevent SSI; focus on other perioperative infection control measures
Key Findings
- •SSI developed in 101 of 352 horses (28.7%) at a mean of 9.7 days postoperatively
- •Sutured-on stent dressing did not significantly reduce SSI rate compared to textile dressing (HR 0.83, p=0.4 unadjusted; HR 0.88, p=0.5 adjusted)
- •No significant differences in secondary outcomes including hospitalisation duration, pyrexia during hospitalisation, or incisional hernia formation at 90 days between groups
- •Single-centre design evaluating primary dressing protection under secondary adhesive and tertiary fabric abdominal bandage during anaesthetic recovery