Use of prophylactic closed incision negative pressure therapy is associated with reduced surgical site infections in gynecologic oncology patients undergoing laparotomy

Chambers, Laura M.; Morton, Molly; Lampert, Erika J.; Yao, Meng; Debernardo, Robert; Rose, Peter G.; Vargas, Roberto

doi:10.1016/j.ajog.2020.05.011

Cited by 10 publications

(8 citation statements)

References 29 publications

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“…A more recent study by Chapman et al of ciNPWT in gynecological oncology patients undergoing laparotomy supported its use in reducing SSI; however, it was a retrospective and nonrandomized study. In their study the group receiving ciNPWT also had a statistically smaller proportion of patients with an ASA grade ≥3 [24], whereas the opposite was the case in ours where our ciNPWT group had a statistically greater proportion of patients with ASA grade ≥3.…”

Section: Discussioncontrasting

confidence: 61%

Closed-Incision Negative Pressure Wound management Following Midline Laparotomy in Gynecological Oncology Operations: A Feasibility Pilot Study

Yin¹,

Lau²,

Mehra³

et al. 2021

Cureus

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IntroductionSurgical site infections (SSIs) are a cause of considerable morbidity and mortality in healthcare. Increasingly, closed-incision negative pressure wound therapy (ciNPWT) is being studied as a potential method of reducing incidence of SSI with conflicting results in the literature. Few studies however have looked at its use in the field of gynecological oncology. ObjectivesWe aimed to compare the incidence of SSI when using ciNPWT dressings versus conventional dressings in gynecological oncology patients undergoing midline laparotomies. MethodsThis was a pilot study involving 14 patients receiving the ciNPWT dressing and 26 control patients. All patients were followed up for a period of 30 days. We used the American College of Surgeons (ACS) risk calculator to estimate each patient's risk of SSI in order to risk stratify the groups. ResultsThe incidence of wound infection was 21% (3/14) in the ciNPWT group and 23% (6/26) in the control group (p=0.886). The ciNPWT group was found to be at significantly higher risk for SSI as calculated by the ACS tool (8.8% ciNPWT, 6% control, p=0.004). After stratifying for this difference in risk, still no significant difference in incidence of SSI was found between the two groups (27% (3/11) ciNPWT, 29% (2/7) control p=0.929). ConclusionThe incidence of SSI does not appear to decrease by the prophylactic use of the closed-incision negative pressure wound dressing.

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Section: Discussioncontrasting

confidence: 61%

Closed-Incision Negative Pressure Wound management Following Midline Laparotomy in Gynecological Oncology Operations: A Feasibility Pilot Study

Yin¹,

Lau²,

Mehra³

et al. 2021

Cureus

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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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“…Retrospective studies have shown the benefit of iNPWT in reducing rates of SSI after laparotomy for gynecologic and general surgery patients [21,22]. However, the results of randomized controlled trials have been mixed.…”

Section: Discussionmentioning

confidence: 99%

A Multi-Modal Approach to Closing Exploratory Laparotomies Including High-Risk Wounds

Andrade

Guerra

Punch

2020

Cureus

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Background Laparotomy incisions with contamination have a high incidence of surgical site infection (SSI). One strategy to reduce SSI has been to allow these wounds to heal by secondary intention; however, this results in an ongoing need for wound care after discharge. Methods A prospectively maintained Acute and Critical Care Surgery database was queried for patients who underwent exploratory laparotomy during 2008-2018. Patients were stratified into two groups: 2008-2015 (no protocol [NP]) and 2016-2018 (closure protocol [CP]). CP patients were operated on by a single surgeon utilizing a multi-modal high-risk incisional closure protocol, which included dilute chlorhexidine lavage, closed suction drains for incisions deeper than 3 centimeters, and incisional negative-pressure wound therapy (iNPWT). The CDC (Centers for Disease Control and Prevention) guidelines were used to determine wound classification and SSI based on chart review. Groups were compared using univariate and multivariate analysis. Results A total of 139 patients met the study criteria. The overall SSI rate, including superficial and deep space infections, was no different in NP versus CP (21.6 vs. 24.1%; p=0.74). The rate of superficial SSI was similar between NP and CP (11.8 vs. 8.4%; p=0.53). Rates of wound closure at discharge were higher in the CP group than the NP group across wound classes, with the greatest difference among dirty wounds (50.0% NP vs. 94.9% CP; p<0.01). CP significantly increased the likelihood of wound closure (OR=179.2; p<0.001) even after controlling for body mass index, wound classification, ASA (American Society of Anesthesiologists) status, and initially open abdomen. Conclusions By addressing both tissue factors and bacterial burden through the use of a multi-modal high-risk incisional closure protocol involving iNPWT, all wounds can be considered for closure without increasing the risk of SSI.

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Use of prophylactic closed incision negative pressure therapy is associated with reduced surgical site infections in gynecologic oncology patients undergoing laparotomy

Cited by 10 publications

References 29 publications

Closed-Incision Negative Pressure Wound management Following Midline Laparotomy in Gynecological Oncology Operations: A Feasibility Pilot Study

Closed-Incision Negative Pressure Wound management Following Midline Laparotomy in Gynecological Oncology Operations: A Feasibility Pilot Study

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

A Multi-Modal Approach to Closing Exploratory Laparotomies Including High-Risk Wounds

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