An international cohort study of wound closure and surgical site infection prevention strategies in abdominal surgery (WOLVERINE): Protocol for a multicenter international study

Background: The European Society of Coloproctology (ESCP) conducted a global survey capturing wound closure practices across a spectrum of surgical contexts, including clean-contaminated and contaminated operations. The results revealed considerable variations in fascial closure techniques, suture types, and infection prevention measures, even within comparable operative scenarios. This variability highlights the urgent need for high-quality, real-world data to inform the development of evidence-based, globally relevant best practices in abdominal surgery. 

Method: The WOLVERINE study is an international, prospective, multicenter cohort study designed to evaluate current wound closure techniques and surgical site infection (SSI) prevention strategies in adult patients undergoing general or colorectal abdominal surgery. The primary objective of this study is to investigate the relationship between wound closure materials and techniques and the development of early and late wound complications. Further objectives include quantifying the burden of wound complications on patient-reported outcomes, health-related quality of life, healthcare utilisation, and postoperative recovery timelines. 

Participating centres include any hospital or surgical unit performing elective, expedited, or emergency abdominal, general, and colorectal operations via open, laparoscopic, or robotic approaches. This study adheres to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting cohort studies. 

Discussion: The WOLVERINE cohort study will provide the first truly global, prospective portrait of abdominal wall closure practice and its short- and long-term sequelae across the full spectrum of elective, expedited, and emergency general and colorectal surgery. This project bridges this fundamental knowledge gap.