Prophylactic closed-incision negative-pressure wound therapy is associated with decreased surgical site infection in high-risk colorectal surgery laparotomy wounds

T Curran, D Alvarez, J Pastrana Del Valle, T E Cataldo, V Poylin, D Nagle, T Curran, D Alvarez, J Pastrana Del Valle, T E Cataldo, V Poylin, D Nagle

Abstract

Aim: Surgical site infection in colorectal surgery is associated with significant healthcare costs, which may be reduced by using a closed-incision negative-pressure therapy device. The aim of this study was to assess the impact of closed-incision negative-pressure therapy on the incidence of surgical site infection.

Method: In this retrospective cohort study we evaluated all patients who had undergone high-risk open colorectal surgery at a single tertiary care centre from 2012 to 2016. We compared the incidence of surgical site infection between those receiving standard postoperative wound care between 2012 and 2014 and those receiving closed-incision negative-pressure therapy via a customizable device (Prevena Incision Management System, KCI, an Acelity company, San Antonio, Texas, USA) between 2014 and 2016. A validated surgical site infection risk score was used to create a 1:1 matched cohort subset.

Results: Negative pressure therapy was used in 77 patients and compared with 238 controls. Negative pressure patients were more likely to have a stoma (92% vs 48%, P < 0.01) and to be smokers (33% vs 15%, P < 0.01). Surgical site infection was higher in control patients (15%, n = 35/238) compared with negative pressure patients (7%, n = 5/77) (P = 0.05). On regression analysis, negative pressure therapy was associated with decreased surgical site infection (OR 0.27; 95% CI 0.09-0.78). These differences persisted in the matched analysis.

Conclusion: Negative pressure therapy was associated with decreased surgical site infection. Negative pressure therapy offers significant potential for quality improvement.

Keywords: Closed incision negative pressure therapy; quality improvement; surgical site infection.

Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.

Figures

Figure 1
Figure 1
Patient selection.
Figure 2
Figure 2
Surgical procedure: CINPTvs non‐CINPT.
Figure 3
Figure 3
Incidence of SSI: nonmatched CINPTvs non‐CINPT (DSSI, deep SSI; SSSI, superficial SSI).
Figure 4
Figure 4
Incidence of SSI: matched CINPTvs non‐CINPT (DSSI, deep SSI; SSSI, superficial SSI).

References

    1. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 2009; 37: 387–97.
    1. Kiran RP, El‐Gazzaz GH, Vogel JD, Remzi FH. Laparoscopic approach significantly reduces surgical site infections after colorectal surgery: data from national surgical quality improvement program. J Am Coll Surg 2010; 211: 232–8.
    1. Kelly KN, Iannuzzi JC, Aquina CT et al Timing of discharge: a key to understanding the reason for readmission after colorectal surgery. J Gastrointest Surg 2015; 19: 418–27; discussion 27‐8.
    1. Wick EC, Shore AD, Hirose K et al Readmission rates and cost following colorectal surgery. Dis Colon Rectum 2011; 54: 1475–9.
    1. Scalise A, Calamita R, Tartaglione C et al Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature. Int Wound J 2016; 13: 1260–81.
    1. Karam RA, Rezk NA, Abdel Rahman TM, Al Saeed M. Effect of negative pressure wound therapy on molecular markers in diabetic foot ulcers. Gene 2018; 667: 56–61.
    1. Hyldig N, Birke‐Sorensen H, Kruse M et al Meta‐analysis of negative‐pressure wound therapy for closed surgical incisions. Br J Surg 2016; 103: 477–86.
    1. Pellino G, Sciaudone G, Selvaggi F, Canonico S. Prophylactic negative pressure wound therapy in colorectal surgery. Effects on surgical site events: current status and call to action. Updates Surg 2015; 67: 235–45.
    1. Sellers MM, Merkow RP, Halverson A et al Validation of new readmission data in the american college of surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2013; 216: 420–7.
    1. Amri R, Dinaux AM, Kunitake H, Bordeianou LG, Berger DL. Risk stratification for surgical site infections in colon cancer. JAMA Surg 2017; 152: 686–90.
    1. Sutton E, Miyagaki H, Bellini G et al Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database. J Surg Res 2017; 207: 205–14.
    1. van Walraven C, Musselman R. The surgical site infection risk score (SSIRS): a model to predict the risk of surgical site infections. PLoS ONE 2013; 8: e67167.
    1. Shen P, Blackham AU, Lewis S et al Phase II randomized trial of negative‐pressure wound therapy to decrease surgical site infection in patients undergoing laparotomy for gastrointestinal, pancreatic, and peritoneal surface malignancies. J Am Coll Surg 2017; 224: 726–37.
    1. Delhougne G, Hogan C, Tarka K, Nair S. A retrospective, cost‐minimization analysis of disposable and traditional negative pressure wound therapy medicare paid claims. Ostomy Wound Manage 2018; 64: 26–33.
    1. Adeyemi A, Waycaster C. Cost‐minimization analysis of negative pressure wound therapy in long‐term care facilities. Wounds 2018; 30: E13–5.
    1. Dolejs SC, Guzman MJ, Fajardo AD et al Bowel preparation is associated with reduced morbidity in elderly patients undergoing elective colectomy. J Gastrointest Surg 2017; 21: 372–9.
    1. Anderson DJ, Podgorny K, Berrios‐Torres SI et al Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35(Suppl 2): S66–88.
    1. Broach RB, Paulson EC, Scott C, Mahmoud NN. Randomized controlled trial of two alcohol‐based preparations for surgical site antisepsis in colorectal surgery. Ann Surg 2017; 266: 946–51.
    1. Sajid MS, Rathore MA, Sains P, Singh KK. A systematic review of clinical effectiveness of wound edge protector devices in reducing surgical site infections in patients undergoing abdominal surgery. Updates Surg 2017; 69: 21–8.
    1. ACS NSQIP User Guide for the 2012 Participant Use Data File 2013 [Available from: .
    1. Lemeshow S, Hosmer DW Jr. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115: 92–106.
    1. Bonds AM, Novick TK, Dietert JB, Araghizadeh FY, Olson CH. Incisional negative pressure wound therapy significantly reduces surgical site infection in open colorectal surgery. Dis Colon Rectum 2013; 56: 1403–8.
    1. Zaidi A, El‐Masry S. Closed‐incision negative‐pressure therapy in high‐risk general surgery patients following laparotomy: a retrospective study. Colorectal Dis 2017; 19: 283–7.
    1. Willy C, Agarwal A, Andersen CA et al Closed incision negative pressure therapy: international multidisciplinary consensus recommendations. Int Wound J 2017; 14: 385–98.
    1. Wick EC, Hirose K, Shore AD et al Surgical site infections and cost in obese patients undergoing colorectal surgery. Arch Surg 2011; 146: 1068–72.
    1. Matatov T, Reddy KN, Doucet LD, Zhao CX, Zhang WW. Experience with a new negative pressure incision management system in prevention of groin wound infection in vascular surgery patients. J Vasc Surg 2013; 57: 791–5.
    1. Semsarzadeh NN, Tadisina KK, Maddox J, Chopra K, Singh DP. Closed incision negative‐pressure therapy is associated with decreased surgical‐site infections: a meta‐analysis. Plast Reconstr Surg 2015; 136: 592–602.
    1. Chopra K, Gowda AU, Morrow C, Holton L 3rd, Singh DP. The economic impact of closed‐incision negative‐pressure therapy in high‐risk abdominal incisions: a cost‐utility analysis. Plast Reconstr Surg 2016; 137: 1284–9.
    1. Frazee R, Manning A, Abernathy S et al Open vs closed negative pressure wound therapy for contaminated and dirty surgical wounds: a prospective randomized comparison. J Am Coll Surg 2018; 226: 507–12.
    1. Lewis LS, Convery PA, Bolac CS, Valea FA, Lowery WJ, Havrilesky LJ. Cost of care using prophylactic negative pressure wound vacuum on closed laparotomy incisions. Gynecol Oncol 2014; 132: 684–9.
    1. Chetter IC, Oswald AV, Fletcher M, Dumville JC, Cullum NA. A survey of patients with surgical wounds healing by secondary intention; an assessment of prevalence, aetiology, duration and management. J Tissue Viability 2016; 26: 103–7.
    1. Ju MH, Ko CY, Hall BL, Bosk CL, Bilimoria KY, Wick EC. A comparison of 2 surgical site infection monitoring systems. JAMA Surg 2015; 150: 51–7.
    1. Taylor JS, Marten CA, Potts KA et al What is the real rate of surgical site infection? J Oncol Pract 2016; 12: e878–83.
    1. Parthasarathy M, Reid V, Pyne L, Groot‐Wassink T. Are we recording postoperative complications correctly? Comparison of NHS hospital episode statistics with the American College of Surgeons National Surgical Quality Improvement Program. BMJ Qual Saf 2015; 24: 594–602.
    1. Mino J, Remzi FH. The use of negative pressure dressings over closed incisions for prevention of surgical site infection in colorectal patients undergoing revisional surgery ‐ a video vignette. Colorectal Dis 2016; 18: 816–7.
    1. Chadi SA, Vogt KN, Knowles S et al Negative pressure wound therapy use to decrease surgical nosocomial events in colorectal resections (NEPTUNE): study protocol for a randomized controlled trial. Trials 2015; 16: 322.

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