Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

• Published in: Journal of the American College of Surgeons Vol. 224; no. 4; pp. 726 - 737
• Main Authors: Shen, Perry, MD, FACS, Blackham, Aaron U., MD, Lewis, Stacey, RN, BSN, Clark, Clancy J., MD, FACS, Howerton, Russell, MD, FACS, Mogal, Harveshp D., MD, Dodson, Rebecca M., MD, Russell, Gregory B., MS, Levine, Edward A., MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Digestive System Neoplasms - surgery; Female; Follow-Up Studies; Humans; Incidence; Laparotomy; Logistic Models; Male; Middle Aged; Negative-Pressure Wound Therapy; Prospective Studies; Risk Factors; Surgery; Surgical Wound Infection - epidemiology; Surgical Wound Infection - etiology; Surgical Wound Infection - prevention & control; Treatment Outcome; Young Adult; SSD; surgical site infection; standard surgical dressing; SSI; CRS/HIPEC; cytoreductive surgery/hyperthermic intraperitoneal chemotherapy; NPWT; negative-pressure wound therapy
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2016.12.028

Background Surgical site infections (SSIs) remain a major source of morbidity and cost after resection of intra-abdominal malignancies. Negative-pressure wound therapy (NPWT) has been reported to significantly reduce SSIs when applied to the closed laparotomy incision. This article reports the results of a randomized clinical trial examining the effect of NPWT on SSI rates in surgical oncology patients with increased risk for infectious complications. Study Design From 2012 to 2016, two hundred and sixty-five patients who underwent open resection of intra-abdominal neoplasms were stratified into 3 groups: gastrointestinal (n = 57), pancreas (n = 73), or peritoneal surface (n = 135) malignancy. They were randomized to receive NPWT or standard surgical dressing (SSD) applied to the incision from postoperative days 1 through 4. Primary outcomes of combined incisional (superficial and deep) SSI rates were assessed up to 30 days after surgery. Results There were no significant differences in superficial SSIs (12.8% vs 12.9%; p > 0.99) or deep SSI (3.0% vs 3.0%; p > 0.99) rates between the SSD and NPWT groups, respectively. When stratified by type of surgery, there were still no differences in combined incisional SSI rates for gastrointestinal (25% vs 24%; p > 0.99), pancreas (22% vs 22%; p > 0.99), and peritoneal surface malignancy (9% vs 9%; p > 0.99) patients. When performing univariate and multivariate logistic regression analysis of demographic and operative factors for the development of combined incisional SSI, the only independent predictors were preoperative albumin (p = 0.0031) and type of operation (p = 0.018). Conclusions Use of NPWT did not significantly reduce incisional SSI rates in patients having open resection of gastrointestinal, pancreatic, or peritoneal surface malignancies. Based on these results, at this time NPWT cannot be recommended as a therapeutic intervention to decrease infectious complications in these patient populations.