Commercial Negative Pressure Wound Therapy vs Novel Non-Commercial Wound Therapy for Vascular Surgery Incisions
Joseph Tingen, Matt Low, Sagar Gandhi
Prisma Health, Greenville, SC
BACKGROUND: Significant morbidity, mortality and cost is associated with surgical site complications (SSCs). A five time increase in hospital readmission and double the mortality rate and likelihood of ICU care for patients with a surgical site infection has been reported1. Inguinal incision SSCs during vascular procedures have been documented as high as 32%2. In 2020, Gombert published a metanalysis of closed incision negative pressure wound therapy (NPWT) versus traditional post-surgical dressing use and found a statistically significant decrease from 28.8% to 11.3% wound infection rate by using closed incision negative pressure therapy3. Our vascular surgery group previously presented results using a novel non-commercial NPWT at Southern Association for Vascular Surgery meeting and found a significant decrease in SSC rates, readmission and re-operation compared to standard incision closure. This retrospective review compares a new disposable commercial-based NPWT system with our previous non-commercial NPWT system given prior encouraging results.
METHODS: A retrospective review of vascular surgery wound complication data from June 2020 through May 2021 for all patients with PREVENA (3M KCI, St. Paul, MN) wound therapy system was performed. The primary endpoint was 30-day SSCs rate (wound infection, hematoma, dehiscence, and lymph leak). Secondary endpoints were readmission and re-operation rates. The patients with PREVENA were compared to our prior patient data with non-commercial NWPT operated on by the same surgeons and undergoing similar operations a year prior.
RESULTS: Patients with PREVENA (n=87) were compared to a recent cohort (n=50) using the non commercial NWPT. PREVENA was predominately used for groin incisions (90.8%). Bypass operations were the most common procedure (33.7%), followed by thromboembolectomies (28.9%), endarterectomies (20.5%), traumatic artery repairs (13.3%), and artery exposure for EVAR/endografts (3.6%). The most common bypass operation was femoral-popliteal bypasses (46.2%). Eleven operations (12.6%) performed were redo groin operations and nine operations (10.3%) were in an infected field. Fifty-three cases (60.9%) were elective and thirty four were emergent. Thirteen patients (14.9%) had a 30-day SSC. Four developed a wound infection, two had a hematoma, four experienced wound dehiscence, and four had a lymph leak/seroma. A total of 5 (5.7%) patients needed readmission and 6 (6.8%) required re-operation. In comparison to our non commercial NPWT system, the PREVENA cohort SSC was 14.9% while non-commercial system was 6.0% (p=0.17). PREVANA cohort readmission was 5.7% versus 4.0% (p=1.0). PREVENA cohort re-operation was 6.8% versus 4.0% (p=0.71). The table summarizes the comparison. CONCLUSIONS: The PREVENA wound therapy system decreases the rate of SSC compared to published historical vascular groin incision complication rates. However, our previously presented data using a non-commercial NPWT system remains superior in regards to SSC, re-admission and re-operation. Vascular surgeons should consider using a NPWT device to decrease incision complications.
|PREVENA (n=87)||13 (14.9%)||5 (5.7%)||6 (6.8%)|
|Novel NPWT (n=50)||3 (6%)||2 (4%)||2 (4%)|
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