Use of negative pressure wound therapy in patients with fracture-related infection more than doubles the risk of recurrence

Vera Sweere; Jonathan Sliepen; Susan Haidari; Melissa Depypere; Maarten Mertens; Frank IJpma; Willem-Jan Metsemakers; Geertje Govaert

doi:10.1016/j.injury.2022.10.014

Use of negative pressure wound therapy in patients with fracture-related infection more than doubles the risk of recurrence

Injury. 2022 Dec;53(12):3938-3944. doi: 10.1016/j.injury.2022.10.014. Epub 2022 Oct 17.

Authors

Vera Sweere¹, Jonathan Sliepen², Susan Haidari¹, Melissa Depypere³, Maarten Mertens⁴, Frank IJpma², Willem-Jan Metsemakers⁵, Geertje Govaert⁶

Affiliations

¹ Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
² Department of Trauma Surgery, University Medical Centre Groningen, Groningen, The Netherlands.
³ Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium.
⁴ Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium.
⁵ Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium.
⁶ Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: g.a.m.govaert@umcutrecht.nl.

PMID: 36424686
DOI: 10.1016/j.injury.2022.10.014

Abstract

Purpose: Fracture-related infection (FRI) is one of the most serious complications in orthopedic trauma surgery. Despite its widespread use, the role of Negative Pressure Wound Therapy (NPWT) remains controversial in the management pathway of FRI. The aim of this study was to assess the relationship between the application of NPWT and its duration and recurrence of infection in operatively treated FRI patients.

Patients and methods: This is a retrospective cohort study based on the FRI database of three level 1 Trauma Centres. Included patients had to be at least 16 years of age and surgically treated for FRI between January 1st 2015 and September 1st 2020. Patients were subdivided in either the NPWT group, when NPWT was applied as part of the FRI treatment, or in the control group, when no NPWT had been applied. To limit confounding, patients were excluded if they (also) underwent NPWT prior to the diagnosis of FRI. The relation between the duration of NPWT during FRI treatment and the recurrence rate of infection was analyzed using a multivariable logistic regression model.

Results: A total of 263 patients were included, 99 in the NPWT group and 164 in the control group. The median duration of NPWT was 18.0 (IQR 15.8) days. In the NPWT group, 28 patients (28.3%) developed a recurrent FRI. In the control group, 19 patients (11.6%) had a recurrent FRI (p = 0.001, 95% CI [0.174 - 0.635]). In the NPWT group there were no significant differences in baseline characteristics between the recurrence and non-recurrence group. The duration of NPWT was associated with a higher risk of recurrence of infection (p = 0.013, OR 1.036, 95% CI [1.008 - 1.066]).

Conclusion: Delayed wound closure with the application of NPWT increased the risk of recurrence of infection in patients with soft tissue defects after FRI treatment. Therefore, it is advised to consider NPWT only as a short-term (e.g. few days) necessity to bridge the period until definitive wound closure can be established.

Keywords: Bone infection; Complications; Fracture; Fracture-related infection; Infection; Negative pressure wound therapy; Orthoplastic Surgery; Osteomyelitis; Re-infection; Recurrence of infection; Wound.

MeSH terms

Fractures, Bone* / etiology
Humans
Negative-Pressure Wound Therapy*
Retrospective Studies
Treatment Outcome