The prevention of inguinal incision complications utilizing a non-commercial, cost-saving negative-pressure wound therapy system
Brian Jones, Samuel Groot, Sagar Gandhi, Bruce Gray, Chris Carsten
Greenville Memorial Hospital, Greenville, SC
BACKGROUND: Significant morbidity is associated with surgical site complications (SSCs), especially in the vascular disease population. Inguinal incision SSCs during vascular procedures have been documented as high as 32% in retrospective, prospective, and randomized trials. Previous data from randomized and non-randomized studies have shown benefit in reducing inguinal incision SSCs using commercial-based, negative pressure wound therapy (NPWT) systems. This study evaluated a cost-saving technique to decrease SSCs for inguinal procedures utilizing a non-commercial incisional NPWT system.
METHODS: From January to July of 2020, consecutive vascular patients at our institution undergoing an open vascular procedure requiring an inguinal incision(s) received a NPWT system incorporating gauze, a 7-French flat Jackson-Pratt drain, and air-tight adhesive dressing after skin closure. Prior to the procedure, standard alcohol-based skin preparation was performed, and a single-dose preoperative intravenous antibiotic was administered. The primary combined endpoint was 30-day SSCs rate (including wound infection, hematoma, dehiscence, and lymph leak). Secondary endpoints included readmission and reoperation rates. These patients were compared to consecutive historical patients from the same time-period, one year prior. Statistical verification was performed using chi-square testing for proportional analysis and unpaired t-tests for continuous variable analysis.
RESULTS: A total of 50 groin incisions utilizing the non-commercial NPWT system were compared to 59 incisions in the historical control. Procedures included access surgeries for delivery of endovascular devices, inflow and outflow revascularizations, and femoral arterial repairs (including thrombectomy, endarterectomy, etc.). There were no significant differences in patient demographics or risk factors (smoking, diabetes, obesity, and use of prosthetic graft). NPWT reduced the SSC rate (primary endpoint) from 20.3% to 6.0% (P = 0.0315) and the readmission rate decreased from 18.6% to 4.0% (P = 0.0193). Reoperation rates trended toward a significant decrease of 4.0% from 15.3% (P = 0.0530). The only SSCs observed in the NPWT cohort were lymphatic leaks (i.e., no wound infections, hematomas, or dehiscence were found). The total cost for the non-commercial NPWT system was $7.12 versus an average $460.35 for the commercial-based products.
CONCLUSIONS: Wound complications can be dramatically reduced with the use of non-commercial NPWT in patients who require inguinal incisions during open vascular procedures.
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