- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03009110
Preventing Adverse Incisional Outcomes at Cesarean Multicenter Trial (Prevena-C)
Prophylactic Negative Pressure Wound Therapy in Obese Women at Cesarean: a Multicenter Randomized Trial
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Experimental evidence suggests that NPWT promotes wound healing by removing exudate, approximating the wound edges, and reducing bacterial contamination. Obesity (body mass index [BMI] ≥30kg/m2) increases the risk for both cesarean delivery and SSIs compared to non-obese women. The increased risk of SSIs is in part due to the increased thickness of the subcutaneous space, allowing collection of exudates and increasing tension on wound edges, promoting the growth of bacteria, and leading to wound infection and breakdown. Thus, prophylactic NPWT may be particularly effective in this patient population.
During the 5-year project period, investigators from 4 collaborating perinatal centers in the United Stated (two university and two community) will randomize 2850 obese women undergoing cesarean delivery to receive either prophylactic negative pressure wound therapy with the Prevena device or standard wound dressing. Women will be followed up to 30 days postoperatively to ascertain study outcomes.
The primary outcome for the trial is superficial or deep SSI after cesarean according to the CDC's National Healthcare Safety Network definitions. The investigators will also assess other wound complications, adverse events potentially attributable to NPWT and cost-effectiveness as measured by incremental cost per case of SSI prevented and per quality-adjusted life year (QALY).
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Alabama
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Birmingham, Alabama, United States, 35233
- University of Alabama Medical Center
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Indiana
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Indianapolis, Indiana, United States, 46202
- Methodist Hospital
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Indianapolis, Indiana, United States, 46202
- Eskenazi Hopsital
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Louisiana
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New Orleans, Louisiana, United States, 70115
- Ochsner Baptist Medical Center
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Missouri
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Saint Louis, Missouri, United States, 63108
- Barnes-Jewish Hospital
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Saint Louis, Missouri, United States, 63141
- Mercy Hosptial St Louis
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria
- Gestational age ≥23weeks
- BMI≥30 Pre-pregnancy or BMI at first prenatal visit
- Planned or unplanned cesarean delivery
Exclusion Criteria:
- Non-availability for postoperative follow-up
- Contraindication to NPWT applicable to women undergoing cesarean: Pre-existing infection around incision site, Bleeding disorder, Therapeutic anticoagulation, Irradiated skin, Allergy to any component of the dressing (e.g. silver, acrylic, silicone, adhesive tape)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Standard Dressing
Women assigned to standard care will receive routine postoperative wound dressing consisting of layers of gauze and adhesive tap.
The dressing will be removed after 24 - 48 hours.
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Standard wound dressing is routine postoperative wound dressing consisting of layers of gauze and adhesive tape.
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Experimental: Prophylactic NPWT
Women assigned to prophylactic NPWT will have the Prevena device applied and secured with fixation adhesion strips.
The device will be monitored while the patient is in the hospital to confirm that it is functioning well.
The device will be removed prior to discharge, typically on postoperative day 4, but longer for up to 7 days for patients who remain hospitalized.
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The Prevena NPWT system is a small, lightweight, portable suction device consisting of an electric motor-driven vacuum pump connected to a proprietary foam and adhesive dressing.
It is supplied as a pump with a sterile dressing kit and two batteries.
Different dressing sizes are available for transverse and vertical incisions ranging from 13 to 20 cm and more.
The pump maintains negative pressure of -125 mmHg to the wound surface.
The device is placed after skin closure.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Superficial or Deep Surgical Site Infections (SSIs)
Time Frame: 30 days postoperatively
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As defined according to the Center for Disease Control and Prevention's (CDC) National Healthcare Safety Network criteria.
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30 days postoperatively
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of Participants With Superficial, Deep or Organ Space SSIs (Individual Types of SSIs)
Time Frame: 30 days postoperatively
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As defined according to the CDC's National Healthcare Safety Network criteria.
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30 days postoperatively
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Number of Participants With Organ Space SSIs (Endometritis, Intraabdominal Abscess)
Time Frame: 30 days postoperatively
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As defined according to the CDC's National Healthcare Safety Network criteria.
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30 days postoperatively
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Number of Participants With Wound Hematoma, Seroma, Separation (Other Wound Complications)
Time Frame: 30 days postoperatively
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Frequency of wound hematoma, seroma, separation (other wound complications).
Hematoma, seroma, separation (2cm or more).
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30 days postoperatively
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Number of Participants With a Composite of Any Wound Complication Including SSI, Hematoma, Seroma, Separation (2cm or More).
Time Frame: 30 days postoperatively
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Frequency of a composite of any wound complication including SSI, hematoma, seroma, separation (2cm or more).
SSI, hematoma, seroma, separation (2cm or more).
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30 days postoperatively
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Patient Pain Score
Time Frame: At discharge, an average of 4 days postoperatively
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On a scale of 0 (least) - 10 (most).
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At discharge, an average of 4 days postoperatively
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Patient Pain Score
Time Frame: At postoperative day 30
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On a scale of 0 (least) - 10 (most).
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At postoperative day 30
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Patient Satisfaction Score
Time Frame: At discharge, an average of 4 days postoperatively
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On a scale of 0 (least) - 10 (most).
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At discharge, an average of 4 days postoperatively
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Patient Satisfaction Score
Time Frame: At postoperative day 30
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On a scale of 0 (least) - 10 (most).
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At postoperative day 30
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Number of Participants With Physician Office Visit, Emergency Room Visit, Attendance at Wound Clinic, Use Antibiotics, Hospital Readmission for Wound Related Problems (Measures of Healthcare Resource Utilization)
Time Frame: 30 days postoperatively
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Frequency of physician office visit, emergency room visit, attendance at wound clinic, use antibiotics, hospital readmission for wound related problems (measures of healthcare resource utilization).
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30 days postoperatively
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Number of Participants With Skin Blistering, Erythema, Wound Bleeding (Measures of Adverse Skin Events)
Time Frame: 30 days postoperatively
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Frequency of skin blistering, erythema, wound bleeding (measures of adverse skin events).
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30 days postoperatively
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Types and Frequency of Different Bacteria Including Methicillin-resistant Staphylococcus Aureus
Time Frame: 30 days postoperatively
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Types and frequency of different bacteria including methicillin-resistant Staphylococcus aureus.
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30 days postoperatively
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Incremental Cost Per SSI Prevented
Time Frame: 30 days postoperatively
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Based on economic analysis to be done along side trial.
Results of the economic analysis will be published separately from the effectiveness and safety data.
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30 days postoperatively
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Incremental Cost Per Quality-Adjusted Life-year
Time Frame: 30 days postoperatively
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Based on economic analysis to be done along side trial.
Results of the economic analysis will be published separately from the effectiveness and safety data.
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30 days postoperatively
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Risk Factors for Surgical Site Infections in Obese Women
Time Frame: 30 days postoperatively
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Based on combined cohort.
Results of the risk factor analysis will be published separately from the effectiveness and safety data.
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30 days postoperatively
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Methodius G Tuuli, MD, MPH, Indiana University School of Medicine
Publications and helpful links
General Publications
- Mark KS, Alger L, Terplan M. Incisional negative pressure therapy to prevent wound complications following cesarean section in morbidly obese women: a pilot study. Surg Innov. 2014 Aug;21(4):345-9. doi: 10.1177/1553350613503736. Epub 2013 Sep 20.
- Swift SH, Zimmerman MB, Hardy-Fairbanks AJ. Effect of Single-Use Negative Pressure Wound Therapy on Postcesarean Infections and Wound Complications for High-Risk Patients. J Reprod Med. 2015 May-Jun;60(5-6):211-8.
- Bullough, L, Wilkinson, D., Burns, S, Wan, L, Changing wound care protocols to reduce postoperative caesarean section infection and readmission, Wounds , 2014 (10), 1 : 72 - 76. 46
- Chaboyer W, Anderson V, Webster J, Sneddon A, Thalib L, Gillespie BM. Negative Pressure Wound Therapy on Surgical Site Infections in Women Undergoing Elective Caesarean Sections: A Pilot RCT. Healthcare (Basel). 2014 Sep 30;2(4):417-28. doi: 10.3390/healthcare2040417.
- Tuuli MG, Liu J, Tita ATN, Longo S, Trudell A, Carter EB, Shanks A, Woolfolk C, Caughey AB, Warren DK, Odibo AO, Colditz G, Macones GA, Harper L. Effect of Prophylactic Negative Pressure Wound Therapy vs Standard Wound Dressing on Surgical-Site Infection in Obese Women After Cesarean Delivery: A Randomized Clinical Trial. JAMA. 2020 Sep 22;324(12):1180-1189. doi: 10.1001/jama.2020.13361.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- IRB ID #: 201603062
- 1R01HD086007-01A1 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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