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A feasibility survey to inform trial design investigating surgical site infection prevention in vascular surgery

Lathan, R; Hitchman, L; Long, J; Gwilym, B; Wall, M; Juszczak, M; Smith, G; Popplewell, M; Bosanquet, DC; Hinchliffe, R; Pinkney, T; Chetter, I


R Lathan

L Hitchman

J Long

B Gwilym

M Wall

M Juszczak

M Popplewell

DC Bosanquet

R Hinchliffe

T Pinkney


Introduction: Current surgical site infection (SSI) prevention guidance indicates low-quality evidence supporting many of their recommendations. Subsequently, there is substantial variation in practice and often implementation of unsubstantiated interventions. There is therefore a need to rapidly evaluate best practices to prevent SSI. This survey aimed to evaluate current practice in the prevention of SSI and equipoise regarding potential interventions to reduce SSI rates in major lower limb amputation (MLLA) and groin incisions.
Methods: A cross-sectional national survey was developed from current international guidelines to prevent SSI, following CHERRIES and CROSS checklists. A study steering committee directed internal validation prior to dissemination via single stage sampling of the membership of the Vascular Society of Great Britain and Ireland.
Results: The survey received 58 responses from clinicians across 38 NHS trusts. Most respondents were consultant vascular surgeons (91%; 53/58). Preoperatively, there was variable practice in the use of preoperative bathing, surgical site preparation, antibiotic prophylaxis duration and the use of incise drapes for both MLLA and groin incisions. Intraoperatively there was little consensus for wound irrigation, drain insertion, changing gloves and instruments prior to skin closure, skin closure technique, and the use of dressings for both MLLA and groin incisions. The majority of respondents were willing to randomise patients to most interventions. Nearly three-quarters (72%; 42/58) of respondents agreed or strongly agreed that a combined outcome measure of SSI and wound dehiscence would be the ideal primary outcome in a trial investigating SSI prevention in MLLA.
Conclusions: Despite significant heterogeneity in practice to prevent SSI, the majority of surgeons surveyed showed they would be willing to randomise to interventions in a randomised controlled trial. This key finding is important in the design of future studies.


Lathan, R., Hitchman, L., Long, J., Gwilym, B., Wall, M., Juszczak, M., …Chetter, I. (2024). A feasibility survey to inform trial design investigating surgical site infection prevention in vascular surgery. Journal of Vascular Societies Great Britain and Ireland, 3(2), 76-83.

Journal Article Type Article
Acceptance Date Feb 21, 2024
Online Publication Date Feb 29, 2024
Publication Date Feb 1, 2024
Deposit Date Mar 5, 2024
Journal Journal of Vascular Societies Great Britain & Ireland
Electronic ISSN 2754-0030
Publisher Vascular Society for Great Britain and Ireland
Peer Reviewed Peer Reviewed
Volume 3
Issue 2
Pages 76-83
Keywords Equipoise; Randomized controlled trial; Surgical site infection; Survey
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