Use of prophylactic closed incision negative pressure therapy is associated with reduced surgical site infections in gynecologic oncology patients undergoing laparotomy.

Abstract

BACKGROUND:

Surgical site infection after surgery for gynecologic cancer increases morbidity. Prophylactic closed incision negative pressure therapy has shown promise in reducing infectious wound complications across many surgical disciplines.

OBJECTIVE:

This study aimed to determine whether closed incision negative pressure therapy is associated with reduced surgical site infections in gynecologic oncology patients undergoing laparotomy compared with standard dressings.

STUDY DESIGN:

This was a retrospective case-control study of patients undergoing laparotomy for known or suspected gynecologic cancer from Jan. 1, 2017, to Feb. 1, 2020. Patients were matched in a 1:3 ratio (closed incision negative pressure therapy to standard dressing) by body mass index, age, diabetes, bowel surgery, smoking, and steroid use. Surgical site infection was defined according to the Centers for Disease Control and Prevention. Multivariable logistic regression using backward selection was performed.

RESULTS:

Of the 1223 eligible patients undergoing laparotomy, 64 (5.2%) received closed incision negative pressure therapy dressings and were matched to 192 (15.7%) controls. There were no differences in medical comorbidities (P>.05), site or stage of malignancy (P>.05), duration of surgery (P=.82), or surgical procedures (P>.05). Use of closed incision negative pressure therapy was associated with reduction in all adverse wound outcomes (20.3% vs 40.1%; P<.001). In particular, closed incision negative pressure therapy was associated with a significant reduction in both superficial incisional surgical site infections (9.4% vs 29.7%; P<.001) and deep incisional surgical site infections (0.0% vs 6.8%; P=.04). In multivariable analysis, use of closed incision negative pressure therapy was associated with significant reduction in the incidence of superficial incisional infections alone (odds ratio, 0.29; 95% confidence interval, 0.12-0.73; P=.008) and both superficial and deep incisional infections (odds ratio, 0.29; 95% confidence interval, 0.12-0.71; P=.007).

CONCLUSION:

Use of prophylactic closed incision negative pressure therapy after laparotomy in gynecologic oncology patients was found to be associated with reduced superficial incisional and deep incisional infections compared with standard dressings. Furthermore, closed incision negative pressure therapy was associated with reduction in all other adverse wound outcomes. Closed incision negative pressure therapy may be considered for surgical site infection prevention in high-risk gynecologic oncology patients undergoing laparotomy.

• Authors: Laura Moulton Chambers, Molly Morton, Erika Lampert, Meng Yao, Robert Debernardo, Peter G Rose, Roberto Vargas
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 223 Issue 5 Pg. 731.e1-731.e9 (11 2020) ISSN: 1097-6868 [Electronic] United States
• PMID: 32417358 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Aged
• Case-Control Studies
• Colostomy
• Digestive System Surgical Procedures
• Fallopian Tube Neoplasms (surgery)
• Female
• Genital Neoplasms, Female (surgery)
• Gynecologic Surgical Procedures (methods)
• Humans
• Hysterectomy
• Ileostomy
• Laparotomy (methods)
• Logistic Models
• Lymph Node Excision
• Middle Aged
• Multivariate Analysis
• Negative-Pressure Wound Therapy (methods)
• Ovarian Neoplasms (surgery)
• Peritoneal Neoplasms (surgery)
• Retrospective Studies
• Salpingo-oophorectomy
• Splenectomy
• Surgical Wound Dehiscence (prevention & control)
• Surgical Wound Infection (prevention & control)
• Uterine Cervical Neoplasms (surgery)
• Uterine Neoplasms (surgery)
• Wound Closure Techniques