Negative pressure wound therapy for emergency laparotomy incisions: A national database propensity matched study

Wardah Rafaqat; Jefferson A Proaño Zamudio; May Abiad; Emanuele Lagazzi; Dias Argandykov; Casey M Luckhurst; George C Velmahos; Michael P DeWane; Haytham M A Kaafarani; John O Hwabejire

doi:10.1016/j.amjsurg.2023.10.055

Negative pressure wound therapy for emergency laparotomy incisions: A national database propensity matched study

Am J Surg. 2024 Feb:228:287-294. doi: 10.1016/j.amjsurg.2023.10.055. Epub 2023 Nov 13.

Affiliations

¹ Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
² Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jhwabejire@mgb.org.

PMID: 37981515
DOI: 10.1016/j.amjsurg.2023.10.055

Abstract

Background: Surgical site infections (SSI) are a common complication of laparotomy incisions. The role of Negative Pressure Wound Therapy (NPWT) in preventing SSIs has not yet been explored in a nationwide analysis. We aimed to evaluate the association of the prophylactic use of NPWT with SSIs in patients undergoing an emergency laparotomy procedure.

Methods: We conducted a retrospective cohort study using the National Surgery Quality Initiative Program (NSQIP) database from 2013 to 2020. We included patients ≥18 years undergoing an emergency laparotomy. We performed a 1:1 propensity matching adjusting for patient age, sex, race, ethnicity, BMI, comorbid conditions, ASA status, diagnosis, preoperative factors and laboratory variables, procedure type, wound class, and intraoperative variables. We compared NPWT with standard dressings in two patient populations: 1. patients with completely closed (skin and fascia) laparotomy incisions and 2. patients with partially closed (fascia only) laparotomy incisions. Our primary outcome was the rate of incisional SSI. Secondary outcomes included the type of SSI, postoperative 30-day complications, postoperative hospital length of stay, and discharge disposition.

Results: We included 65,803 patients with completely closed incisions of whom 387 patients received NPWT. There was no significant difference in the rate of total SSIs (13.4 % vs. 11.9 %; p = 0.52) in the matched population of 387 pairs. We included 7285 patients with partially closed incisions of whom 477 patients received NPWT. There was no significant difference in the rate of total SSIs (3.6 % vs. 4.4 %; p = 0.51) in the matched population of 477 pairs. Secondary outcomes did not differ significantly in either group.

Conclusion: The rate of SSIs was not significantly different when prophylactic NPWT was used compared to standard dressings for patients with a closed or partially closed laparotomy incision.

Keywords: Emergency; Laparotomy; NPWT; Negative pressure wound therapy.

MeSH terms

Humans
Laparotomy* / adverse effects
Laparotomy* / methods
Negative-Pressure Wound Therapy* / methods
Retrospective Studies
Surgical Wound Infection / epidemiology
Surgical Wound Infection / etiology
Surgical Wound Infection / prevention & control