Incisional Negative Pressure Wound Therapy is Protective of Postoperative Cardiothoracic Wound Infection
Kaitlin A. Nguyen, BS; George A. Taylor, MD, MS, Theresa K. Webster, BS, Rachel A. Jenkins, BS, Nicklaus S. Houston, BS, Dylan L. Kahler, MD, Andrew A. Gassman, MD, Christine M. Jones, MD
Temple University Division of Plastic and Reconstructive Surgery, Philadelphia, PA
Background: Sternal wound infections are a rare but life-threatening complication of cardiothoracic surgery, with an incidence of 1-5% and an associated mortality between 6 and 30%. In 2016, use of Prevena™ Negative Pressure Wound VAC system was introduced at our institution to decrease infection rates and promote wound healing. In contrast to negative pressure therapy used previously for treatment of open wounds, Prevena™ was applied intraoperatively to closed surgical incisions and kept in place for 5-7 days. This study sought to determine whether Prevena™ therapy reduced wound infection and improved outcomes in cardiothoracic surgery.
Methods: A retrospective cohort study was performed including all adult patients who underwent nontraumatic cardiothoracic surgery at a single institution between 2016 and 2018 (n=1199). Patient characteristics, clinical variables, and surgical outcomes were compared between those who did and did not receive an incisional Prevena™ Negative Pressure Wound VAC system postoperatively. Multivariable regression analyses determined factors predictive or protective of developing a surgical wound infection.
Results: Prevena™ was used in 706 (58.9%) of the 1199 patients who underwent surgery within the study period. The patients who received incisional negative pressure wound therapy were found to be older (mean age 63.39 years vs 61.28, p = 0.01), had higher rates of hyperlipidemia (55.7% vs 43.0%, p < 0.01), statin use (56.4% vs 50.3%, p = 0.04), and anti-hypertensive use (70.4% vs 64.9%, p < 0.05). Despite these differences, the use of incisional negative pressure wound therapy was found to significantly reduce rates of both wound infection (3.0% vs 6.3%, p = 0.01) and readmission specifically for wound infection (0.7% vs 2.6%, p = 0.01). After controlling for clinically confounding variables, the use of incisional negative pressure wound therapy was found to be a protective factor in the development of surgical wound infection (odds ratio 0.497, 95% confidence interval 0.262 - 0.945). The number of patients needed to treat with incisional negative pressure wound therapy to prevent a sternal wound infection is 30 patients.
Conclusions: This study analyzed the efficacy of incisional negative pressure wound therapy at preventing postoperative cardiothoracic wound infection in the largest population studied to date. The unadjusted and adjusted results of this study support the expanded use of negative pressure therapy on surgical incisions, as postoperative use of incisional negative pressure wound therapy was found to be an effective strategy to reduce infection rates following cardiothoracic surgery.
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