Cesarean Delivery with External Negative Pressure Dressing System: A Retrospective Cohort Study

Abstract

Objective To determine whether the use of external negative pressure dressing system (ENPDS) can reduce the incidence of wound complications after cesarean delivery (CD) compared with traditional dressings.

Methods Retrospective review of all patients undergoing CD between November 2011 and March 2013. Information was collected on demographics, body mass index (BMI), duration of labor, pre- and postnatal infections, incision and dressing type, and postoperative course. Comparisons were made between traditional dressing and an external negative pressure dressing system.

Results Of 970 patients included in the study, wound complications occurred in 50 patients (5.2%). Comparisons of ENPDS (n = 103) and traditional dressing (n = 867) groups revealed higher wound complications for ENPDS with odds ratio (OR) 3.37 and confidence interval (CI) 1.68 to 6.39. ENPDS was more commonly used in patients with BMI > 30 and preexisting diabetes. After controlling for BMI and pregestational diabetes in logistic regression analysis, ENPDS was equivalent to traditional dressing for risk of wound complications with an adjusted OR 2.76 (CI 0.97 to 7.84), with a trend toward more wound complications with ENPDS. Wound separation also tended to be more common in ENPDS group versus traditional dressing with an adjusted OR 2.66 (CI 0.87 to 8.12), although this result did not reach significance.

Conclusion ENPDS is equivalent to traditional dressing for preventing wound complications after controlling for the higher-risk population selected for its use. In particular, wound separation appears to occur more frequently in women treated with ENPDS versus traditional dressing and should be regarded as a potential hazard of the system.

Keywords

negative pressure - wound therapy - cesarean delivery - cesarean section

Note

Presented as a poster at The 2014 Annual Clinical Meeting of the American College of Obstetricians and Gynecologists held April 26 to 30 in Chicago, Illinois.

• References

• 1 Menaker F, Hamilton BE. Recent Trends in Cesarean Delivery in the United States. NCHS Data Brief, no. 35. Hyattsville, MD: National Center for Health Statistics; 2010
• 2 Basha SL, Rochon ML, Quiñones JN, Coassolo KM, Rust OA, Smulian JC. Randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery. Am J Obstet Gynecol 2010; 203 (03) 285.e1-285.e8
• 3 Alanis MC, Villers MS, Law TL, Steadman EM, Robinson CJ. Complications of cesarean delivery in the massively obese parturient. Am J Obstet Gynecol 2010; 203 (03) 271.e1-271.e7
• 4 Owen J, Andrews WW. Wound complications after cesarean sections. Clin Obstet Gynecol 1994; 37 (04) 842-855
• 5 Olsen MA, Butler AM, Willers DM, Devkota P, Gross GA, Fraser VJ. Risk factors for surgical site infection after low transverse cesarean section. Infect Control Hosp Epidemiol 2008; 29 (06) 477-484 , discussion 485–486
• 6 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. ; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20 (04) 250-278 , quiz 279–280
• 7 Nielsen TF, Hökegård KH. Postoperative cesarean section morbidity: a prospective study. Am J Obstet Gynecol 1983; 146 (08) 911-916
• 8 Sarsam SE, Elliott JP, Lam GK. Management of wound complications from cesarean delivery. Obstet Gynecol Surv 2005; 60 (07) 462-473
• 9 Masden D, Goldstein J, Endara M, Xu K, Steinberg J, Attinger C. Negative pressure wound therapy for at-risk surgical closures in patients with multiple comorbidities: a prospective randomized controlled study. Ann Surg 2012; 255 (06) 1043-1047
• 10 Reddix Jr RN, Leng XI, Woodall J, Jackson B, Dedmond B, Webb LX. The effect of incisional negative pressure therapy on wound complications after acetabular fracture surgery. J Surg Orthop Adv 2010; 19 (02) 91-97
• 11 Stannard JP, Robinson JT, Anderson ER, McGwin Jr G, Volgas DA, Alonso JE. Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma. J Trauma 2006; 60 (06) 1301-1306
• 12 Bonds AM, Novick TK, Dietert JB, Araghizadeh FY, Olson CH. Incisional negative pressure wound therapy significantly reduces surgical site infection in open colorectal surgery. Dis Colon Rectum 2013; 56 (12) 1403-1408
• 13 Mark KS, Alger L, Terplan M. Incisional negative pressure therapy to prevent wound complications following cesarean section in morbidly obese women: a pilot study. Surg Innov 2014; 21 (04) 345-349
• 14 Chaboyer W, Anderson V, Webster J, Sneddon A, Thalib L, Gillespie BM. Negative pressure wound therapy on surgical site infections in women undergoing elective caesarean sections: a pilot RCT. Healthcare 2014; 2 (04) 417-428
• 15 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. ; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61 (04) 344-349