Negative Pressure Wound Dressing Reduces Surgical Site Infections in Infants after Closed Abdominal Procedures: A Preliminary ReportFunding None.
20 December 2017
25 April 2018
19 June 2018 (eFirst)
Introduction Negative pressure wound therapy (NPWT) is a novel tool to reduce surgical site infections (SSIs). Although SSIs are a common source of morbidity in infants undergoing laparotomy, the cost of the available NPWT devices has restricted its use to adult high-risk patients. We developed a low-cost method of NPWT in infants and analyzed its impact on the incidence of SSIs in infant patients.
Patients and Methods A consecutive series of infants (age ≤ 12 months) who underwent a clean-contaminated, contaminated, or dirty abdominal procedure via laparotomy from 08/2015 to 12/2016 were included. The choice of the applied dressing, either NPWT or standard surgical dressing (SSD), was made at the surgeon's discretion. SSIs were documented prospectively. The Horan definition and the Clavien-Dindo classification were used. The cost of material was calculated for both groups.
Results Ninety-three consecutive patients were included (65 SSD and 28 NPWT). SSI occurred in 10 patients in the SSD group, Grade I in 7 and Grade II in 3 (Clavien-Dindo classification). No SSI occurred in patients with NPWT (p < 0.05). The cost of an SSD was less than 1 €, and the cost of a NPWT was less than 10 €.
Conclusion The routine use of this modified vacuum wound dressing may be an efficient and affordable technique to decrease SSIs in infants who underwent contaminated abdominal operations.
- 1 Dumville JC, Gray TA, Walter CJ. , et al. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev 2016; 12: CD003091
- 2 Gillespie BM, Chaboyer W, Erichsen-Andersson A, Hettiarachchi RM, Kularatna S. Economic case for intraoperative interventions to prevent surgical-site infection. Br J Surg 2017; 104 (02) e55-e64
- 3 Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 1997; 38 (06) 553-562
- 4 Venturi ML, Attinger CE, Mesbahi AN, Hess CL, Graw KS. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) Device: a review. Am J Clin Dermatol 2005; 6 (03) 185-194
- 5 Hyldig N, Birke-Sorensen H, Kruse M. , et al. Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg 2016; 103 (05) 477-486
- 6 De Vries FE, Wallert ED, Solomkin JS. , et al. A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery. Medicine (Baltimore) 2016; 95 (36) e4673
- 7 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
- 8 Dorafshar AH, Franczyk M, Gottlieb LJ, Wroblewski KE, Lohman RF. A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device. Ann Plast Surg 2012; 69 (01) 79-84
- 9 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. ; Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Am J Infect Control 1999; 27 (02) 97-132
- 10 Sethi MV, Zimmer J, Ure B, Lacher M. Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery. J Pediatr Surg 2016; 51 (04) 630-633
- 11 Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13 (10) 606-608
- 12 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
- 13 O'Leary DP, Peirce C, Anglim B. , et al. Prophylactic negative pressure dressing use in closed laparotomy wounds following abdominal operations: a randomized, controlled, open-label trial: the P.I.C.O. trial. Ann Surg 2017; 265 (06) 1082-1086
- 14 Karlakki S, Brem M, Giannini S, Khanduja V, Stannard J, Martin R. Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery: a review of evidence and mechanisms for an emerging indication. Bone Joint Res 2013; 2 (12) 276-284
- 15 Grauhan O, Navasardyan A, Hofmann M, Müller P, Stein J, Hetzer R. Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg 2013; 145 (05) 1387-1392
- 16 Zaidi A, El-Masry S. Closed-incision negative-pressure therapy in high-risk general surgery patients following laparotomy: a retrospective study. Colorectal Dis 2017; 19 (03) 283-287
- 17 Horwitz JR, Chwals WJ, Doski JJ, Suescun EA, Cheu HW, Lally KP. Pediatric wound infections: a prospective multicenter study. Ann Surg 1998; 227 (04) 553-558
- 18 Duque-Estrada EO, Duarte MR, Rodrigues DM, Raphael MD. Wound infections in pediatric surgery: a study of 575 patients in a university hospital. Pediatr Surg Int 2003; 19 (06) 436-438
- 19 Bhattacharyya N, Kosloske AM. Postoperative wound infection in pediatric surgical patients: a study of 676 infants and children. J Pediatr Surg 1990; 25 (01) 125-129
- 20 Chopra K, Gowda AU, Morrow C, Holton III L, Singh DP. The economic impact of closed-incision negative-pressure therapy in high-risk abdominal incisions: a cost-utility analysis. Plast Reconstr Surg 2016; 137 (04) 1284-1289
- 21 Lewis LS, Convery PA, Bolac CS, Valea FA, Lowery WJ, Havrilesky LJ. Cost of care using prophylactic negative pressure wound vacuum on closed laparotomy incisions. Gynecol Oncol 2014; 132 (03) 684-689
- 22 Muensterer OJ, Keijzer R. A simple vacuum dressing reduces the wound infection rate of single-incision pediatric endosurgical appendectomy. JSLS 2011; 15 (02) 147-150
- 23 Visser R, Milbrandt K, Lum Min S. , et al. Applying vacuum to accomplish reduced wound infections in laparoscopic pediatric surgery. J Pediatr Surg 2017; 52 (05) 849-852
- 24 Gomoll AH, Lin A, Harris MB. Incisional vacuum-assisted closure therapy. J Orthop Trauma 2006; 20 (10) 705-709