S116: Impact of incisional negative pressure wound therapy on surgical site infection after complex incisional hernia repair: a retrospective matched cohort study

Hopkins, Brent; Eustache, Jules; Ganescu, Olivia; Cipolla, Josie; Kaneva, Pepa; Fried, Gerald M.; Khwaja, Kosar; Vassiliou, Melina C.; Fata, Paola; Lee, Lawrence; Feldman, Liane S.

doi:10.1007/s00464-020-07857-1

Cited by 10 publications

(7 citation statements)

References 34 publications

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“…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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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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“…We chose patients with the need of VHR and fully standardised the operative procedure to minimise the limitations of other studies. 12,13 In an attempt to show the potential advantage of iNPWT in the management and prevention of SSO, we chose the mesh-based reparation of ventral hernia as a rather standardised setting of clean surgery. This was previously reported in other studies with heterogeneous results.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of deep SSI between the iNPWT and conventional group only differs significantly within 30 days and the effect diminishes after 180 days of follow-up. 13 The reason for prolonged wound problems in spite of iNPWT might be due to the physical properties of iNPWT. In deeper layers of the scarred tissue, the effectiveness of iNPWT significantly decreases and therefore does not substantially impede long-term effects on epifascial seroma, especially after removing the dressing.…”

Section: Discussionmentioning

confidence: 99%

“…We try to diminish this selection effect by employing a matched-pair analysis. 13 We inaugurated iNPWT in a large patient cohort receiving elective surgery and dealing with large wounds in a non-contaminated field. We were not able to lower the wound impairment rate in our selected patients but levelled out a very heterogeneous patient cohort by a matched-pair analysis to continue further studies.…”

Section: Discussionmentioning

confidence: 99%

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Use of incisional preventive negative pressure wound therapy in open incisional hernia repair: Who benefits?

Leuchter

Hitzbleck

Schafmayer

et al. 2021

Wound Repair Regeneration

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Complex surgery of abdominal wall hernia continues to bear the major concern of wound healing disorders. Technical modifications have not been able to sufficiently prevent wound healing impairments or infections, even in clean elective cases, especially when dealing with large-scale hernia defects. Incisional negative pressure wound therapy (iNPWT) in its intentional use as a preventive tool has recently found its way from theoretical and experimental advantages to the clinical routine. Different indications have been defined but evidence is lacking. We performed a retrospec-

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“…Eight papers were identified in this review that exclusively addressed prophylactic incisional (closed-wound) negative pressure wound therapy after ventral hernia repair. One had to be discarded because a full text was not found (27)(28)(29)(30)(31)(32)(33). All studies seem consistent in reporting lower rates of SSI and SSO when using pNPWT (Table 3).…”

Section: Prophylactic Negative Pressure Wound Therapy (Pnpwt)mentioning

confidence: 98%

The European Hernia Society Prehabilitation Project: A Systematic Review of Intra-Operative Prevention Strategies for Surgical Site Occurrences in Ventral Hernia Surgery

et al. 2022

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BackgroundVentral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, pre- and intra-operative strategies have received increasing focus in recent years. To assess possible preventive surgical strategies, this European Hernia Society endorsed project was launched. The aim of this review was to evaluate the current literature focusing on pre- and intra-operative strategies for surgical site occurrences (SSO) and specifically surgical site infection (SSI) in ventral hernia repair.MethodsA systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases used were Pubmed and Web of Science. Original retrospective or prospective human adult studies describing at least one intra-operative intervention to reduce SSO after ventral hernia repair were considered eligible.ResultsFrom a total of 4775 results, a total of 18 papers were considered suitable after full text reading. Prehospital chlorhexidine gluconate (CHG) scrub appears to increase the risk of SSO in patients undergoing ventral hernia repair, while there is no association between any type of surgical hat worn and the incidence of postoperative wound events. Intraoperative measures as prophylactic negative pressure therapy, surgical drain placement and the use of quilt sutures seem beneficial for decreasing the incidence of SSO and/or SSI. No positive effect has been shown for antibiotic soaking of a synthetic mesh, nor for the use of fibrin sealants.ConclusionThis review identified a limited amount of literature describing specific preventive measures and techniques during ventral hernia repair. An advantage of prophylactic negative pressure therapy in prevention of SSI was observed, but different tools to decrease SSIs and SSOs continuously further need our full attention to improve patient outcomes and to lower overall costs.

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S116: Impact of incisional negative pressure wound therapy on surgical site infection after complex incisional hernia repair: a retrospective matched cohort study

Cited by 10 publications

References 34 publications

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

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

Use of incisional preventive negative pressure wound therapy in open incisional hernia repair: Who benefits?

The European Hernia Society Prehabilitation Project: A Systematic Review of Intra-Operative Prevention Strategies for Surgical Site Occurrences in Ventral Hernia Surgery

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