Closed Incision Negative Pressure Therapy to Reduce Surgical Site Infection in High-Risk Gastrointestinal Surgery: A Randomized Controlled Trial

Author:

Ceppa Eugene P1,Kim Rachel C1,Niedzwiecki Donna2,Lowe Melissa E3,Warren Dana A4,House Michael G1,Nakeeb Attila1,Zani Sabino5,Moyer Ashley N4,Blazer Dan G5,

Affiliation:

1. From the Department of Surgery, Indiana University, Indianapolis, IN (Ceppa, Kim, House, Nakeeb)

2. Department of Biostatistics and Bioinformatics (Niedzwiecki), Duke University Medical Center, Durham, NC.

3. Biostatistics Shared Resource (Lowe), Duke University Medical Center, Durham, NC.

4. Duke Cancer Institute (Warren, Moyer), Duke University Medical Center, Durham, NC.

5. Department of Surgery (Zani, Blazer), Duke University Medical Center, Durham, NC.

Abstract

BACKGROUND: Despite institutional perioperative bundles and national infection prevention guidelines, surgical site infection (SSI) after a major abdominal operation remains a significant source of morbidity. Negative pressure therapy (NPT) has revolutionized care for open wounds but the role of closed incision NPT (ciNPT) remains unclear. STUDY DESIGN: We conducted a multi-institutional randomized controlled trial evaluating SSI after major elective colorectal or hepatopancreatobiliary surgery (Clinical Trial Registration: NCT01905397). Patients were randomized to receive conventional wound care vs ciNPT (Prevena Incision Management System, 3M Health Care, San Antonio, TX). The primary endpoint was postoperative incisional SSI. SSI incidence was evaluated at inpatient days 4 or 5 and again at postoperative day 30. With 144 patients studied, the estimated power was 85% for detecting a difference in SSIs between 17% and 5% (conventional vs ciNPT; 1-sided α = 0.1). Secondary endpoints included SSI type, length of stay, 30-day readmission, and mortality. T-tests were used to compare continuous variables between treatments; similarly, chi-square tests were used to compare categorical variables. A p value of <0.05 was considered significant, except in the primary comparison of incisional and organ SSIs. RESULTS: During the 2013 to 2021 time period, 164 patients were randomized, and of those, 138 were evaluable (ciNPT n = 63; conventional n = 75). Incisional SSIs occurred in 9 (14%) patients in the ciNPT group and 13 (17%) patients in the conventional group (p = 0.31). Organ or space SSIs occurred in 7 (11%) patients in the ciNPT group and 10 (13%) in the conventional therapy group (p = 0.35). CONCLUSIONS: In this multi-institutional, randomized controlled trial of patients undergoing colorectal or hepatopancreatobiliary surgery, incidence of incisional SSIs between ciNPT and conventional wound therapy was not statistically significant. Future trials should focus on patient populations undergoing specific procedures types that have the highest risk for SSI.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery

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