To Close or not to Close? The Impact of Abdominal Skin Closure Techniques on Subtypes of Surgical Site Infections in Emergent Surgery

There is debate regarding whether to close the skin in open emergent abdominal cases with class III and IV wounds. We aimed to compare outcomes between open vs closed skin management. A retrospective cohort study of adult patients with class III/IV wounds was performed. Groups included primary skin closure (closed) or non-primary (open) closure. 751 patients were included with 47% in the closed cohort. The open cohort had lower incidence of superficial SSI, but higher incidence of deep SSI in univariable analysis. Organ space SSI did not differ between groups. On multivariable analysis, closed skin was an independent predictor of superficial SSI (AOR = 1.80), but not deep or organ SSI. Open skin management was associated with less superficial SSI despite being used in more complex and high-risk cases; however, it was not protective against deep or organ SSI.