Small Bite Fascial Closure Technique Associated With Reduction in Fascial Dehiscence

Abstract

Introduction

Abdominal fascial dehiscence (FD) is a postoperative complication with significant morbidity and mortality. The incidence of FD exceeded the national average at our institution. As small bite fascial closure technique has been shown to decrease dehiscence rate compared with traditional 10 mm bites in elective low-risk populations, we hypothesized that a 5 mm bite and 5 mm travel fascial closure technique would be associated with a lower FD rate in patients undergoing both elective and emergent laparotomy at our institution.

Methods

Patients undergoing an operation requiring a midline laparotomy were identified. Cohort periods were defined as preintervention (January 6, 2019, to May 31, 2021) and postintervention (April 1, 2022, to June 30, 2023). Intervention consisted of simulation laboratory education and training for surgical residents and faculty regarding small bite fascial closure technique. Demographics and outcomes were compared. The primary outcome was FD as identified by Patient Safety Indicator 14 or International Classification of Diseases, Tenth Revision, code and confirmed via chart review. Statistical comparisons were performed using either Kruskal–Wallis analysis of variance or Fisher's exact test (P < 0.05). Regression analysis was performed to estimate the effects of various predictors on the log odds of the outcome.

Results

There were 1611 patients in the preintervention cohort and 906 patients in the postintervention cohort. Demographics and outcomes were similar between the two cohorts. The average body mass index was 29 kg/m² in both groups. The dehiscence rate significantly decreased from preintervention to postintervention based on the both International Classification of Diseases, Tenth Revision (2.05% versus 0.88%, P = 0.029) and Patient Safety Indicator 14 definitions (0.99% versus 0.22%, P = 0.028).

Conclusions

This study demonstrated that the small bite and small travel fascial closure technique was associated with a significant reduction in the rate of FD in patients undergoing laparotomy at our institution in an overweight patient population. This technique offers a teachable and low-cost method to mitigate this complication.