Prophylactic negative-pressure wound therapy for prevention of surgical site infection in abdominal surgery: a nationwide cross-sectional survey

Elin Roos, Jonathan Douissard, Ziad Abbassi, Nicolas C Buchs, Christian Toso, Frédéric Ris, Jeremy Meyer, Elin Roos, Jonathan Douissard, Ziad Abbassi, Nicolas C Buchs, Christian Toso, Frédéric Ris, Jeremy Meyer

Abstract

Our objective was to determine current practice in Switzerland regarding the use of pNPWT in abdominal surgery. An online survey was carried out to evaluate the use of pNPWT among abdominal surgeons in Switzerland. One hundred and ten participants replied to the survey from 16.12.2019 to 15.01.2020. Eleven were excluded, leaving 99 responders for analysis. Seventy participants (70.7%) were using pNPWT, 3 (3%) have stopped using it and 26 (26.3%) have never used it. pNPWT was used on midline laparotomy by 63 responders (90%), closed stoma wounds by 21 (30%), closed perineal wounds by 20 (28.6%), Pfannenstiel incisions by 18 (23.7%), groin incisions by 16 (22.9%), subcostal incisions by 13 (18.6%), Mc Burney incisions by 3 (4.3%) and other incisions by 18 (25.7%). Forty-eight participants (68.6%) used pNPWT on less than 10% of patients, 14 (20%) on 10-25% of patients, six (8.6%) on 25-50% of patients and two (2.9%) on 75-100% of patients. Suggestions for improvement to pNPWT were: better sealing, recyclable system, better adaptation to the perineum, smaller device, reduced cost and possibility to check the surgical wound through the dressing. In conclusion, pNPWT is widely used among Swiss surgeons, mostly on midline incisions. However, most of them apply pNPWT on a small proportion of patients only. Suggestions for improvement were a better sealing for complex wounds, reduced cost and possibility to check the wound during the therapy.

Keywords: Negative therapy; Negative-pressure therapy; PICO; PREVENA.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Use of pNPWT among Swiss surgeons practising abdominal surgery. a Information regarding pNPWT among Swiss surgeons. b Use of pNPWT among Swiss surgeons in abdominal surgery. c Time when pNPWT was made available in Swiss surgeons’ institutions. d Time when Swiss surgeons have first used pNPWT in abdominal surgery
Fig. 2
Fig. 2
Types of pNPWT systems used by Swiss surgeons for abdominal surgery. a pNPWT systems available for Swiss surgeons in their institutions. b pNPWT systems used by Swiss surgeons
Fig. 3
Fig. 3
Indications for pNPWT among Swiss surgeons for abdominal surgery. a Types of wounds on which Swiss surgeons applied pNPWT. b Proportions of patients on which Swiss surgeons applied pNPWT. c Minimal number of risk factors for wound-related complications considered by Swiss surgeons to be an indication for pNPWT

References

    1. Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2019;3:CD009261.
    1. Zwanenburg PR, Tol BT, Obdeijn MC, Lapid O, Gans SL, Boermeester MA. Meta-analysis, meta-regression, and GRADE assessment of randomized and nonrandomized studies of incisional negative pressure wound therapy versus control dressings for the prevention of postoperative wound complications. Ann Surg. 2020;272(1):81–91. doi: 10.1097/SLA.0000000000003644.
    1. Sahebally SM, McKevitt K, Stephens I, Fitzpatrick F, Deasy J, Burke JP, et al. Negative pressure wound therapy for closed laparotomy incisions in general and colorectal surgery: a systematic review and meta-analysis. JAMA Surg. 2018;153(11):e183467. doi: 10.1001/jamasurg.2018.3467.
    1. Meyer J, Roos E, Abbassi Z, Buchs NC, Ris F, Toso C. Prophylactic negative-pressure wound therapy prevents surgical site infection in abdominal surgery: an updated systematic review and meta-analysis of randomized controlled trials and observational studies. Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa1203.
    1. Shepard J, Ward W, Milstone A, Carlson T, Frederick J, Hadhazy E, et al. Financial impact of surgical site infections on hospitals: the hospital management perspective. JAMA Surg. 2013;148(10):907–914. doi: 10.1001/jamasurg.2013.2246.
    1. Kuper TM, Murphy PB, Kaur B, Ott MC. Prophylactic negative pressure wound therapy for closed laparotomy incisions: a meta-analysis of randomized controlled trials. Ann Surg. 2020;271(1):67–74. doi: 10.1097/SLA.0000000000003435.
    1. Eval&GO (2019)
    1. (NICE) NIfHaCE (2019) PICO negative pressure wound dressings for closed surgical incisions 2019.
    1. Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e288–e303. doi: 10.1016/S1473-3099(16)30402-9.
    1. Chung A, Vogler S, Finlayson S, Sklow B. Incisional negative pressure therapy reduces perineal superficial wound infections following abdominoperineal resection. Dis Colon Rectum. 2014;57:5 (e306–e307).
    1. Rather A, Fisher A, Nedelcoviciu R, Alexander E. Perineal wound complications after initiation of closed incision negative pressure therapy in patients undergoing APR: a comparative study. Dis Colon Rectum. 2018;61:5 (e293–e294).
    1. Takahashi Y, Miyoshi N, Nishimura J, Yasui M, Asukai K, Yanagimoto Y, et al (2018) Negative-pressure wound therapy for perineum surgical wound of rectal cancer patients after chemoradiation therapy. Cancer Sci, 109(Supplement 2 (1363-))
    1. Chadi SA, Kidane B, Britto K, Brackstone M, Ott MC. Incisional negative pressure wound therapy decreases the frequency of postoperative perineal surgical site infections: a cohort study. Dis Colon Rectum. 2014;57(8):999–1006. doi: 10.1097/DCR.0000000000000161.
    1. Sumrien H, Newman P, Burt C, McCarthy K, Dixon A, Pullyblank A, et al. The use of a negative pressure wound management system in perineal wound closure after extralevator abdominoperineal excision (ELAPE) for low rectal cancer. Tech Coloproctol. 2016;20(9):627–631. doi: 10.1007/s10151-016-1495-6.
    1. van der Valk MJM, de Graaf EJR, Doornebosch PG, Vermaas M. Incisional negative-pressure wound therapy for perineal wounds after abdominoperineal resection for rectal cancer, a pilot study. Adv Wound Care (New Rochelle) 2017;6(12):425–429. doi: 10.1089/wound.2017.0749.
    1. Wiegering A, Dietz UA, Corteville C, Plassmeier L, Jurowich C, Germer CT, et al. Impact of incisional negative pressure wound therapy on perineal wound healing after abdominoperineal rectum extirpation. Int J Colorectal Dis. 2017;32(2):291–293. doi: 10.1007/s00384-016-2704-5.
    1. Meyer J, Roos E, Abbassi Z, Toso C, Ris F, Buchs NC. The role of perineal application of prophylactic negative-pressure wound therapy for prevention of wound-related complications after abdomino-perineal resection: a systematic review. Int J Colorectal Dis. 2021;36(1):19–26. doi: 10.1007/s00384-020-03732-6.
    1. Bullard KM, Trudel JL, Baxter NN, Rothenberger DA. Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon Rectum. 2005;48(3):438–443. doi: 10.1007/s10350-004-0827-1.
    1. Artioukh DY, Smith RA, Gokul K. Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma. Colorectal Dis. 2007;9(4):362–367. doi: 10.1111/j.1463-1318.2006.01159.x.
    1. Wiatrek RL, Thomas JS, Papaconstantinou HT. Perineal wound complications after abdominoperineal resection. Clin Colon Rectal Surg. 2008;21(1):76–85. doi: 10.1055/s-2008-1055325.
    1. Roos E, Toso C, Meyer J. COMMENT ON: Meta-analysis, meta-regression, and GRADE assessment of randomized and nonrandomized studies of incisional negative pressure wound therapy versus control dressings for the prevention of postoperative wound complications. Ann Surg, Accepted for publication.
    1. Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y, et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014;101(11):1439–1447. doi: 10.1002/bjs.9600.
    1. Fischer JP, Basta MN, Mirzabeigi MN, Bauder AR, Fox JP, Drebin JA, et al. A risk model and cost analysis of incisional hernia after elective, abdominal surgery based upon 12,373 cases: the case for targeted prophylactic intervention. Ann Surg. 2016;263(5):1010–1017. doi: 10.1097/SLA.0000000000001394.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa