Does Alexis© wound protector/retractor reduce the risk of surgical site infections after open radical cystectomy for bladder cancer? Results from a single center, comparative study

Objective: To assess if Alexis© dual-ring wound protector/retractor reduced the incidence of superficial and deep incisional infection following open radical cystectomy (ORC) METHODS: Since January 2020, all procedures were performed using the Alexis© retractor. We retrospectively review our ORC database and compared patients who were operated on with Alexis© with the same number of consecutive patients operated with a stainless steel retractor in the previous period. Data are presented as median and (interquartile range) RESULTS: 74 patients underwent RC with Alexis© (group 1) and 74 with stainless steel retractor (group 2). Median age was 73.0(13) in group 1, 73.5(14) in group 2 (p=0.338). There were 59(79.7%) men in both groups. The groups were comparable in terms of comorbidities, BMI, ASA score, and neoadjuvant chemotherapy rate. There was no statistically significant difference in type of lymph node dissection and urinary diversion, total surgical time. Postoperative stay was shorter in group 1 [8(4) days vs 9(4) in group 2, p=0.012]. Group 2 had a significantly higher rate of both superficial (8.1% vs 18.9%, p=0.045) and deep incisional infection (2.7% vs 14.9%, p=0.009). At multivariable analysis, body mass index (OR 1.129 95% CI 1.162-1.283, p=0.043) was significantly associated with higher odds of superficial incisional infection. The use of Alexis© was significantly associated with lower odds of having both superficial (OR 0.274 95%CI 0.033-0.781, p=0.023) and deep incisional infection (OR 0.159 95% CI 0.034-0.745, p=0.020).