Closed incision wound-vac may reduce colorectal surgery SSIs

Last Updated: 2017-07-12

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Closed incision negative pressure therapy (CINPT) for wounds may help prevent surgical site infection (SSI) after colorectal surgery, according to researchers at Beth Israel Deaconess Medical Center in Boston.

They presented their findings June 11 at the 2017 American Society of Colon and Rectal Surgeons Annual Scientific Meeting in Seattle, Washington.

The research team evaluated the impact of CINPT on SSI incidence in a group of high-risk patients having open colorectal surgery laparotomy, i.e., patients with pre- or post-op stoma, obesity, diabetes mellitus, pre-op steroid or immunosuppressant use, or a contaminated or dirty wound.

In this high-risk group, “CINPT decreased surgical site infection by about half," coauthor Dr. Thomas Curran told Reuters Health.

"The importance of this study is that it clarified some of the findings that had been done in often heterogeneous patient populations, so in choosing this high-risk homogeneous group, we were able to have a more applicable result for clinicians who are dealing with this type of patient population," he said in a phone interview.

"While we do see that CINPT lowered surgical site infection and was statistically significant on a multivariable analysis, the cost-effectiveness piece is something people are always concerned with. At least preliminarily, our data seem to support that CINPT would be cost effective," he noted. "The scope of the problem for surgical site infection is quite significant. It is costly as well as adversely impactful on patients. If we are able to do something to mitigate the risk, that serves the patients well."

Between 2014 and 2016, all high-risk patients received CINPT through a customizable device (Prevena Incision Management System, Acelity, San Antonio, Texas) applied over the intact incision for five to seven days.

The researchers compared all CINPT cases reviewed by the National Surgery Quality Improvement Project (NSQIP) with similar institutional NSQIP-reviewed historical controls.

Characteristics of the CINPT and the non-CINPT patients were compared using the two-sided t-test or the Fisher’s exact test; SSI was determined through NSQIP review; and independent predictors of SSI were found using multiple logistic regression.

Overall, 112 high-risk open colorectal patients were treated by CINPT; 77 were reviewed by the NSQIP and compared with 238 non-CINPT cases. More CINPT patients had a stoma (92% vs 48%, p<0.001) and were current or recent smokers within the past year (33% vs 15%, p=0.001).

Groups had similar percentages of patients with obesity (40% vs 48%, p=0.294), diabetes (18% vs 25%, p=0.278), the use of pre-op steroids or immunosuppression (30% vs 34%, p=0.578), and a contaminated or dirty wound (57% vs 52%, p=0.600).

On multiple logistic regression, CINPT was associated with a lower incidence of SSI (odds ratio, 0.267; 95% confidence interval, 0.092 to 0.777).

The average time to SSI diagnosis was longer for CINPT patients than for those without CINPT (18 vs 13 days post-op; p=0.01).

"The strengths of the study are that this is the largest series of colorectal patients undergoing CINPT therapy to date, so from that standpoint it lends something to the literature. The weakness is that it is not a randomized controlled study," Dr. Curran said.

"My understanding is that several of those are in process, and we look forward to those data," he added.

SOURCE: http://bit.ly/2u1rZ9B

American Society of Colon and Rectal Surgeons 2017.