Incisional Negative Pressure Therapy to Prevent Wound Complications Following Cesarean Section in Morbidly Obese Women

Mark, Katrina; Alger, Lindsay S.; Terplan, Mishka

doi:10.1177/1553350613503736

Cited by 44 publications

(42 citation statements)

References 24 publications

(24 reference statements)

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“…16 Similarly, Mark and colleagues had no postoperative infections in a group of 21 obese patients versus a 10% rate in 42 historical controls. 17 In our RCT, we also demonstrated a reduction in wound complications, which is consistent with these recent studies in high-risk populations. The results of this study are consistent with other data that suggest that ciNPT may reduce wound complications in high-risk women.…”

Section: Resultssupporting

confidence: 92%

Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial

Gunatilake

Swamy

Brancazio

et al. 2017

AJP Rep

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Background Postcesarean wound morbidity is a costly complication of cesarean delivery for which preventative strategies remain understudied. Objective We compared surgical site occurrences (SSOs) in cesarean patients receiving closed-incision negative-pressure therapy (ciNPT) or standard-of-care (SOC) dressing. Study Design A single-center randomized controlled trial compared ciNPT (5–7 days) to SOC dressing (1–2 days) in obese women (body mass index [BMI] ≥ 35), undergoing cesarean delivery between 2012 and 2014. Participants were randomized 1:1 and monitored 42 ± 10 days postoperatively. The primary outcome SSOs included unanticipated local inflammation, wound infection, seroma, hematoma, dehiscence, and need for surgical or antibiotic intervention. Results Of the 92 randomized patients, 82 completed the study. ciNPT and SOC groups had similar baseline characteristics. Mean BMI was 46.5 ± 6.5 and no treatment-related serious adverse events. Compared with SOC, the ciNPT group had fewer SSOs (7/43 [16.3%] vs. 2/39 [5.1%], respectively; p = 0.16); significantly fewer participants with less incisional pain both at rest (39/46 [84.8%] vs. 20/46 [43.5%]; p < 0.001) and with incisional pressure (42/46 [91.3%] vs. 25/46 [54.3%]; p < 0.001); and a 30% decrease in total opioid use (79.1 vs. 55.9 mg morphine equivalents, p = 0.036). Conclusion A trend in SSO reduction and a statistically significant reduction in postoperative pain and narcotic use was observed in women using ciNPT.

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Section: Resultssupporting

confidence: 92%

Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial

Gunatilake

Swamy

Brancazio

et al. 2017

AJP Rep

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“…Other reports have suggested post-operative silver dressings may reduce incidence of SSI in different wound types [12,13]. NPWT applied to closed incisions using full-sized durable NPWT pumps has been reported to reduce the incidence of post-cesarean SSI [14] although this study examined a morbidly obese group in which BMI was in excess of 45 kg/m 2 . The evidence and mechanisms for incisional NPWT has recently been reviewed systematically [15].…”

Section: Discussionmentioning

confidence: 89%

A Journey to Zero: Reduction of Post-Operative Cesarean Surgical Site Infections over a Five-Year Period

Hickson

Harris

Brett

2015

Surgical Infections

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Background: Surgical site infections (SSI) are a substantial concern for cesarean deliveries in which a surgical site complication is most unwelcome for a mother with a new infant. Steps taken pre-and post-operatively to reduce the number of complications may be of substantial benefit clinically, economically, and psychologically. Methods: A risk-based approach to incision management was developed and implemented for all cesarean deliveries at our institution. A number of incremental interventions for low-risk and high-risk patients including pre-operative skin preparations, standardized pre-and post-operative protocols, post-operative nanocrystalline silver antimicrobial barrier dressings, and incisional negative pressure wound therapy (NPWT) were implemented sequentially over a 5-y period. A systematic clinical chart review of 4,942 patients spanning all cesarean deliveries between 2007-2012 was performed to determine what effects the interventions had on the rate of SSI for cesarean deliveries. Results: The percentage of SSI was reduced from 2.13% (2007) to 0.10% (2012) (p < 0.0001). There were no substantial changes in the patient population risk factors over this time. As a result of the changes in incision management practice, a total of 92 cesarean post-operative SSIs were avoided: A total cost saving of nearly $5,000,000. Conclusion: Applying a clinical algorithm for assessing the risk of surgical site complication and making recommendations on pre-operative and post-operative incision management can result in a substantial and sustainable reduction in cesarean SSI.

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“…Recently there have been reports on the use of negative pressure therapy in the treatment of wounds after total knee and hip replacement surgery (10), traumatic wounds in the lower limbs (11), Cesarean's section wounds (12), wounds after vascular surgical procedures in the lower limbs (13), extensive laparotomies (14) and sternotomies (15). Analyses of studies that evaluated use of negative pressure therapy of primarily closed wounds focus on documentation of reduced incidence of infections of postoperative wounds in patients with co-morbidities, with predicted risk of problematic wound healing.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Outcome of Treatment of Postoperative Primarily Closed Sternotomy Wounds Treated Using Negative Pressure Wound Therapy

Witt-Majchrzak¹,

Żelazny²,

Snarska³

2015

Polish Journal of Surgery

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Hospital infections, and in particular infections of the surgical site are a common problem of the procedural departments. Due to continuous progress of surgical techniques and patient population getting older with multiple co-morbidities, multidirectional actions need to be taken to avoid these infections or, if they do occur, achieve optimal treatment outcomes. Vacuum wound therapy is one of the directions that has been developed over the recent years.evaluate wound healing in patients after an off-pump coronary artery bypass grafting procedure, using the internal mammary artery, treated with negative pressure wound therapy system.This prospective, open label study evaluated healing of postoperative sternotomy wounds after their primary closure with negative pressure wound therapy, using continuous negative pressure of -80 mmHg in 40 patients and 40 patients in a control group in whom conventional dressings were applied in the postoperative period.The number of patients in whom primary wound healing occurred without complications was significantly higher in the negative pressure wound therapy group versus the control group (xNegative pressure wound therapy after primary wound closure reduces the risk of superficial infections in the population with multiple risk factors of complications in the sternotomy wound healing.

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Incisional Negative Pressure Therapy to Prevent Wound Complications Following Cesarean Section in Morbidly Obese Women

Abstract: This pilot study suggests a decrease in wound complications in morbidly obese women receiving incisional negative pressure therapy following cesarean section.

Cited by 44 publications

References 24 publications

Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial

Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial

A Journey to Zero: Reduction of Post-Operative Cesarean Surgical Site Infections over a Five-Year Period

Preliminary Outcome of Treatment of Postoperative Primarily Closed Sternotomy Wounds Treated Using Negative Pressure Wound Therapy

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