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Negative Pressure Wound Therapy for Surgical-site Infections

A Randomized Trial

Javed, Ammar A. MD*,†; Teinor, Jonathan BS*,†; Wright, Michael MS*,†; Ding, Ding MD, MS*,†; Burkhart, Richard A. MD*,†; Hundt, John MHS; Cameron, John L. MD*,†; Makary, Martin A. MD, MPH*,†; He, Jin MD, PhD*,†; Eckhauser, Frederic E. MD*,†; Wolfgang, Christopher L. MD, PhD*,†; Weiss, Matthew J. MD*,†

doi: 10.1097/SLA.0000000000003056
RANDOMIZED CONTROLLED TRIALS
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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.

*The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD

Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.

Reprints: Matthew J. Weiss, MD, FACS, The Johns Hopkins Hospital, 600 N. Wolfe Street/Blalock 685, Baltimore, MD 21287. E-mail: mweiss5@jhmi.edu.

Funding: KCI/Acelity (Grant number #125164).

The authors report no conflict of interests.

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