Javed AA, Teinor J, Wright M, Ding D, Burkhart RA, Hundt J, Cameron JL, Makary MA, He J, Eckhauser FE, Wolfgang CL, Weiss MJ, et al.
Annals of surgery. Date of publication 2018 Oct 10;volume ():.
1. Ann Surg. 2018 Oct 10. doi: 10.1097/SLA.0000000000003056. [Epub ahead of print]
Negative Pressure Wound Therapy for Surgical-site Infections: A Randomized Trial.
Javed AA(1)(2), Teinor J(1)(2), Wright M(1)(2), Ding D(1)(2), Burkhart RA(1)(2),
Hundt J(2), Cameron JL(1)(2), Makary MA(1)(2), He J(1)(2), Eckhauser FE(1)(2),
Wolfgang CL(1)(2), Weiss MJ(1)(2).
Author information:
(1)The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The
Johns Hopkins Hospital, Baltimore, MD.
(2)Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
OBJECTIVE: This study seeks to evaluate the efficacy of negative pressure wound
therapy for surgical-site infection (SSI) after open pancreaticoduodenectomy.
BACKGROUND: Despite improvement in infection control, SSIs remain a common cause
of morbidity after abdominal surgery. SSI has been associated with an increased
risk of reoperation, prolonged hospitalization, readmission, and higher costs.
Recent retrospective studies have suggested that the use of negative pressure
wound therapy can potentially prevent this complication.
METHODS: We conducted a single-center randomized, controlled trial evaluating
surgical incision closure during pancreaticoduodenectomy using negative pressure
wound therapy in patients at high risk for SSI. We randomly assigned patients to
receive negative pressure wound therapy or a standard wound closure. The primary
end point of the study was the occurrence of a postoperative SSI. We evaluated
the economic impact of the intervention.
RESULTS: From January 2017 through February 2018, we randomized 123 patients at
the time of closure of the surgical incision. SSI occurred in 9.7% (6/62) of
patients in the negative pressure wound therapy group and in 31.1% (19/61) of
patients in the standard closure group (relative risk = 0.31; 95% confidence
interval, 0.13-0.73; P = 0.003). This corresponded to a relative risk reduction
of 68.8%. SSIs were found to independently increase the cost of hospitalization
by 23.8%.
CONCLUSIONS: The use of negative pressure wound therapy resulted in a
significantly lower risk of SSIs. Incorporating this intervention in surgical
practice can help reduce a complication that significantly increases patient harm
and healthcare costs.
DOI: 10.1097/SLA.0000000000003056
PMID: 30308616
