Negative Pressure Wound Therapy for Surgical-site Infections

Abstract

Objective: This study seeks to evaluate the efficacy of negative pressure wound therapy for surgical-site infection (SSI) after open pancreaticoduodenectomy. Background: Despite improvement in infection control, SSIs remain a common cause of morbidity after abdominal surgery. SSI has been associated with an increased risk of reoperation, prolonged hospitalization, readmission, and higher costs. Recent retrospective studies have suggested that the use of negative pressure wound therapy can potentially prevent this complication. Methods: We conducted a single-center randomized, controlled trial evaluating surgical incision closure during pancreaticoduodenectomy using negative pressure wound therapy in patients at high risk for SSI. We randomly assigned patients to receive negative pressure wound therapy or a standard wound closure. The primary end point of the study was the occurrence of a postoperative SSI. We evaluated the economic impact of the intervention. Results: From January 2017 through February 2018, we randomized 123 patients at the time of closure of the surgical incision. SSI occurred in 9.7% (6/62) of patients in the negative pressure wound therapy group and in 31.1% (19/61) of patients in the standard closure group (relative risk ¼ 0.31; 95% confidence interval, 0.13-0.73; P ¼ 0.003). This corresponded to a relative risk reduction of 68.8%. SSIs were found to independently increase the cost of hospitalization by 23.8%. Conclusions: The use of negative pressure wound therapy resulted in a significantly lower risk of SSIs. Incorporating this intervention in surgical practice can help reduce a complication that significantly increases patient harm and healthcare costs.

Negative pressure wound therapy enhances bone regeneration compared with conventional therapy in a rabbit radius gap‑healing model

“…NPWT produces a conducive microenvironment for the stimulation of granulation tissue and subsequent wound healing via open-cell foam dressing and negative pressure (5). Several mechanisms of action underlying NPWT have been proposed, including the reduction of wound tissue edema and bacterial colonization, promotion of cell proliferation and increased local blood perfusion (5)(6)(7)(8). In addition, NPWT is used as an adjuvant therapy in orthopedic surgery for the treatment of traumatic wounds and surgical incisions (9)(10)(11)(12).…”

Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials

“…Though there have been several retrospective studies suggesting a large reduction in SSI rates following prophylactic NPWT use [23,24], there remains a lack of consensus on the evidence from randomised controlled trials (RCT) [25][26][27][28]. Recently, there have been several meta-analyses reporting on NPWT but with considerable inclusion/exclusion limitations.…”

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

“…An RCT analysed 123 high-risk patients allocated to receive either iNPWT or SD after pancreatic surgery [ 55 ]. The overall SSI rate was 15–20%, which is lower compared to the existing literature in this population.…”