Prophylactic Negative-pressure Dressings Reduce Wound Complications and Resource Burden After Emergency Laparotomies

Liu, David Shi Hao; Cheng, Chao; Islam, Rumana; Tacey, Mark; Sidhu, Ankur; Lam, David; Strugnell, Neil

doi:10.1016/j.jss.2020.07.063

Cited by 11 publications

(14 citation statements)

References 35 publications

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“…This nationwide multicenter study showed that the prophylactic use of NPWT and delayed sutures was significantly associated with a lower incidence of iSSI after emergency surgery for colorectal perforation. Several previous, smaller studies have suggested the prophylactic effect of NPWT for emergency contaminated surgery 18–20 . However, to the best of our knowledge, the present study is the first large‐scale study to demonstrate the prophylactic effect of NPWT against iSSI after highly contaminated emergency laparotomies.…”

Section: Discussionmentioning

confidence: 60%

“…Several previous, smaller studies have suggested the prophylactic effect of NPWT for emergency contaminated surgery. 18 , 19 , 20 However, to the best of our knowledge, the present study is the first large‐scale study to demonstrate the prophylactic effect of NPWT against iSSI after highly contaminated emergency laparotomies. Moreover, specific subpopulations that might likely benefit from NPWT were explored.…”

Section: Discussionmentioning

confidence: 73%

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Prophylactic effect of negative‐pressure wound therapy and delayed sutures against incisional‐surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study

Nakatsutsumi

Endo

Asano

et al. 2022

Annals of Gastroent Surgery

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Aim The prophylactic effect of negative‐pressure wound therapy against incisional surgical site infection after highly contaminated laparotomies has not been sufficiently explored. This study aimed to evaluate the prophylactic effect of negative‐pressure wound therapy against incisional surgical site infection after emergency surgery for colorectal perforation. Methods This nationwide, multicenter, retrospective cohort study analyzed data from the 48 emergency hospitals certificated by the Japanese Society for Abdominal Emergency Medicine. Patients who underwent an emergency laparotomy for colorectal perforation between April 2015 and March 2020 were included in this study. Outcomes, including the incidence of incisional surgical site infection, were compared between patients who were treated with prophylactic negative‐pressure wound therapy and delayed sutures (i.e., negative‐pressure wound therapy group) and patients who were treated with regular wound management (i.e., control group) using 1:4 propensity score matching analysis. Results The negative‐pressure wound therapy group comprised 88 patients, whereas the control group consisted of 1535 patients. Of them, 82 propensity score‐matched pairs (negative‐pressure wound therapy group: 82; control group: 328) were evaluated. The negative‐pressure wound therapy group showed a lower incidence of incisional surgical site infection [18 (22.0%) in the negative‐pressure wound therapy group and 115 (35.0%) in the control group, odds ratio, 0.52; 95% confidence interval, 0.30 to 0.92; p = 0.026]. Conclusions The prophylactic use of negative‐pressure wound therapy with delayed sutures was associated with a lower incidence of incisional surgical site infection after emergency surgery for colorectal perforation.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 73%

Prophylactic effect of negative‐pressure wound therapy and delayed sutures against incisional‐surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study

Nakatsutsumi

Endo

Asano

et al. 2022

Annals of Gastroent Surgery

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“…The 84 studies identified encompassed cardiac surgery (n = 8), general abdominal surgery (n = 21), obstetric and gynecologic surgery (n = 8), orthopedic surgery (n = 16), plastic surgery (n = 16), and vascular surgery (n = 15). 11–16,20–97…”

Section: Resultsmentioning

confidence: 99%

“…The included studies represent a global surgical patient population with 7451 patients receiving ciNPT and 16,085 patients receiving SOC across 16 countries. 11–16,20–97 The countries represented included the USA (n = 42), Germany (n = 11), Australia (n = 6), Canada (n = 5), Italy (n = 4), Spain (n = 3), the UK (n = 3), Denmark (n = 2), and one each from Austria, Brazil, France, Ireland, the Netherlands, South Africa, Taiwan, and Turkey. Dressings used in the SOC population varied and included gauze dressings, antimicrobial hydrofiber dressings, absorbent dressings, hydrocolloid dressings, occlusive dressings, or foam dressings.…”

Section: Resultsmentioning

confidence: 99%

Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

Cooper

Singh

Gabriel

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Surgical site complications (SSCs), such as surgical site infection (SSI), dehiscence, seroma, hematoma, and skin necrosis, are associated with increased patient morbidity and mortality. 1 Patients who develop SSCs often experience delayed wound healing, decreased quality of life, and increases in length of stay (LOS), medical procedures performed, pain, and potential reoperation and readmission. [1][2][3] Increased use of resources with management Reconstructive ORiginal aRticleIntroduction: Closed incision negative pressure therapy (ciNPT) has been utilized to help manage closed incisions across many surgical specialties. This systematic review and meta-analysis evaluated the effect of ciNPT on postsurgical and health economic outcomes. Methods: A systematic literature search using PubMed, EMBASE, and QUOSA was performed for publications written in English, comparing ciNPT to standard-of-care dressings between January 2005 and August 2021. Study participant characteristics, surgical procedure, dressings used, treatment duration, postsurgical outcomes, and follow-up data were extracted. Meta-analyses were performed using random-effects models. Risk ratios summarized dichotomous outcomes. Difference in means or standardized difference in means was used to assess continuous variables reported on the same scale or outcomes reported on different scales/measurement instruments. Results: The literature search identified 84 studies for analysis. Significant reductions in surgical site complication (SSC), surgical site infection (SSI), superficial SSI, deep SSI, seroma, dehiscence, skin necrosis, and prolonged incisional drainage were associated with ciNPT use (P < 0.05). Reduced readmissions and reoperations were significant in favor of ciNPT (P < 0.05). Patients receiving ciNPT had a 0.9-day shorter hospital stay (P < 0.0001). Differences in postoperative pain scores and reported amounts of opioid usage were significant in favor of ciNPT use (P < 0.05). Scar evaluations demonstrated improved scarring in favor of ciNPT (P < 0.05). Discussion: For these meta-analyses, ciNPT use was associated with statistically significant reduction in SSCs, SSIs, seroma, dehiscence, and skin necrosis incidence. Reduced readmissions, reoperation, length of hospital stay, decreased pain scores and opioid use, and improved scarring were also observed in ciNPT patients.

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“…Although several randomized controlled trials have evaluated the use of closed NPWT in patients who underwent elective surgery with less intraabdominal contamination, the efcacy and safety of NPWT have not been determined because the preventive efect of SSI varied among trials and studies even in a meta-analysis [14][15][16][17][18]. On the other hand, a low incidence of SSI was reported with the use of NPWT for contaminated wounds [11][12][13][19][20][21]; NPWT may thus be suitable for use on severely contaminated wounds. We conducted the present study to examine the safety and efcacy of open NPWT with DPC for contaminated wounds.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Prophylactic Negative-Pressure Wound Therapy with Delayed Primary Closure for Contaminated Abdominal Wounds

Sato

Sunami²,

Hirano³

et al. 2022

Surgery Research and Practice

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Background. Prophylactic negative-pressure wound therapy (NPWT) to prevent surgical site infection (SSI) may be effective for severely contaminated wounds. We investigated the safety and efficacy of NPWT with delayed primary closure (DPC) for preventing SSI. Methods. For patients with contaminated and dirty/infected surgical wounds after an emergency laparotomy, the abdominal fascia was closed with antibacterial absorbent threads and the skin was left open. Negative pressure (−80 mmHg) was applied through the polyurethane foam, which was replaced on postoperative days 3 and 7. DPC was performed when sufficient granulation was observed. The duration and adverse events of NPWT, the development of SSI, and the postoperative hospital stay were retrospectively reviewed. Results. We analyzed the cases of patients with contaminated (n = 15) and dirty/infected wounds (n = 7). The median duration of NPWT was 7 days (range 5–11 days). NPWT was discontinued in one (4.5%) patient due to wound traction pain. SSI developed in seven patients (31.8%), with incisional SSI in one (4.5%) and organ/space SSI in six (27.3%). The median postoperative hospital stay was 17 days (range 7–91 days). There was no significant relationship between postoperative hospital stay and wound classification ( P = 0.17 ) or type of SSI ( P = 0.07 ). Conclusion. Prophylactic NPWT with DPC was feasible and may be particularly suitable for severely contaminated wounds, with a low incidence of incisional SSI.

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Prophylactic Negative-pressure Dressings Reduce Wound Complications and Resource Burden After Emergency Laparotomies

Cited by 11 publications

References 35 publications

Prophylactic effect of negative‐pressure wound therapy and delayed sutures against incisional‐surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study

Prophylactic effect of negative‐pressure wound therapy and delayed sutures against incisional‐surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study

Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

Efficacy of Prophylactic Negative-Pressure Wound Therapy with Delayed Primary Closure for Contaminated Abdominal Wounds

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