Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology

23-04-2024 | Vacuum Therapy | Peritoneal Surface Malignancy

Negative Pressure Wound Therapy to Reduce Surgical Site Infections after CRS/HIPEC

Authors: Kylie J. Nabata, MD, Sabrina Rai, Darren Zhao, Andrea J. MacNeill, MD, Trevor D. Hamilton, MD

Published in: Annals of Surgical Oncology

Login to get access

Abstract

Background

Surgical site infections (SSIs) are a common cause of morbidity after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Negative pressure wound therapy (NPWT) has been proposed as a method to reduce the rates of SSIs; however, there is paucity in the literature on the efficacy in this population. The goal of this study was to determine whether routine use of NPWT in patients undergoing CRS/HIPEC could reduce the risk of developing SSI.

Methods

We performed a retrospective before–after study to assess the rates of SSI with NPWT compared with a standard postoperative surgical dressing (SSD) in all patients undergoing CRS/HIPEC from November 2013 to December 2021 at a single tertiary care center. The primary outcome was rate of SSI. A multivariate logistic regression analysis was performed to evaluate for risk factors for SSI.

Results

A total of 178 patients were treated with CRS/HIPEC over the study period. Seventy patients had placement of SSD, and 108 patients had placement of NPWT. Rates of SSI were 11.4% (8/70) and 5.6% (6/108) in the two groups, respectively (p = 0.16). On multivariate analysis, patients treated with NPWT had a significantly lower risk of developing an SSI (OR 0.24 [0.06, 0.92], p = 0.037). Patients living >50 km from the hospital had significantly higher risk of developing SSI (OR 2.03 [1.09, 3.78], p = 0.026).

Conclusions

These results suggest that routine use of NPWT can reduce the risk of developing an SSI in patients undergoing CRS/HIPEC for peritoneal malignancy.
Literature
1.
Boyce JM, Potter-Bynoe G, Dziobek L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hospital Epidemiol. 1990;11(2):89–95.CrossRef
2.
CDC N, DHQP. Surgical site infection event (SSI). 2021.
3.
Poulsen K, Bremmelgaard A, Sørensen A, et al. Estimated costs of postoperative wound infections: a case-control study of marginal hospital and social security costs. Epidemiol Infect. 1994;113(2):283–95.CrossRefPubMedPubMedCentral
4.
Shen P, Blackham AU, Lewis S, et al. 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. J Am Coll Surg. 2017;224(4):726–37.CrossRefPubMedPubMedCentral
5.
Vegas AA, Jodra VM, García ML. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Eur J Epidemiol. 1993;504-10.
6.
Lau WY, Fan ST, Chu KW, et al. Combined topical povidone–iodine and systemic antibiotics in postappendicectomy wound sepsis. Br J Surg. 2005;73(12):958–60.CrossRef
7.
Pinkney TD, Calvert M, Bartlett DC, et al. Impact of wound edge protection devices on surgical site infection after laparotomy: Multicentre randomised controlled trial (ROSSINI Trial). BMJ. 2013;347.
8.
Smibert OC, Slavin MA, Teh B, et al. Epidemiology and risks for infection following cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. Supp Care Cancer. 2020;28(6):2745–52.CrossRef
9.
Jedrzejko N, Wong A, MacNeill AJ, et al. Predictors of small bowel obstruction post-cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Gastrointest Surg. 2022;26(10):2176–83.CrossRefPubMed
10.
Gupta N, Kumar V, Garg R, et al. Anesthetic implications in hyperthermic intraperitoneal chemotherapy. J Anaesthesiol Clin Pharmacol. 2019;35(1):3–11.CrossRefPubMedPubMedCentral
11.
Vallicelli C, Coccolini F, Sartelli M, et al. Antibiotic prophylaxis for surgical site infection in general surgery: oncological treatments and HIPEC. Antibiotics. 2022;11(1):43.CrossRef
12.
Alyami M, Kim BJ, Villeneuve L, et al. Ninety-day post-operative morbidity and mortality using the National Cancer Institute’s common terminology criteria for adverse events better describe post-operative outcome after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Int J Hypertherm. 2018;34(5):532–7.CrossRef
13.
Lynam S, Mark KS, Temkin SM. Primary placement of incisional negative pressure wound therapy at time of laparotomy for gynecologic malignancies. Int J Gynecol Cancer. 2016; 26(8).
14.
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 Innovation. 2014;21(4):345–9.CrossRef
15.
Scalise A, Calamita R, Tartaglione C, et al. Improving wound healing and preventing surgical site complications of closed surgical incisions: A possible role of incisional negative pressure wound therapy. A systematic review of the literature. Int Wound J. 2016;13(6):1260–81.CrossRefPubMed
16.
17.
Willy C, Agarwal A, Andersen CA, et al. Closed incision negative pressure therapy: International multidisciplinary consensus recommendations. Int Wound J. 2017;14(2):385–98.CrossRefPubMed
18.
Putri IL, Adzalika LB, Pramanasari R, et al. Negative pressure wound therapy versus conventional wound care in cancer surgical wounds: A meta-analysis of observational studies and randomised controlled trials. Int Wound J. 2022;19(6):1578–93.CrossRefPubMedPubMedCentral
19.
Lawrence SA, McIntyre CA, Pulvirenti A, et al. Perioperative bundle to reduce surgical site infection after pancreaticoduodenectomy: A prospective cohort study. J Am Coll Surg. 2019;228(4):595–601.CrossRefPubMedPubMedCentral
20.
O’Neill CH, Martin RC. Negative-pressure wound therapy does not reduce superficial SSI in pancreatectomy and hepatectomy procedures. J Surg Oncol. 2020;122(3):480–6.CrossRefPubMed
21.
Holm C, Petersen JS, Grønbœk F, et al. Effects of occlusive and conventional gauze dressings on incisional healing after abdominal operations. Eur J Surg. 1998;164(3):179–83.CrossRefPubMed
22.
Boland PA, Kelly ME, Donlon NE, et al. Prophylactic negative pressure wound therapy for closed laparotomy wounds: A systematic review and meta-analysis of randomised controlled trials. Irish J Med Sci (1971-). 2021;190:261–7.CrossRef
23.
Berard F. Postoperative wound infections: The influence of ultraviolet irradiation of the operating room and various other factors. Ann Surg. 1964;160:1–192.PubMed
24.
Serra F, Sergi W, Spatafora F, et al. Negative pressure wound therapy (NPWT) after cytoreductive surgery (CRS) and intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies: preliminary report. Il Giornale di Chirurgia J Italian Surg Assoc. 2019;40(6):578–82.
25.
Blackham AU, Farrah JP, McCoy TP, et al. Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy. Am J Surg. 2013;205(6):647–54.CrossRefPubMed
26.
Kubek EW, Badeau A, Materazzi S, et al. Negative-pressure wound therapy and the emerging role of incisional negative pressure wound therapy as prophylaxis against surgical site infections. Microbial pathogens and strategies for combating them: Science, technology and education. FORMATEX. 2013.
27.
28.
Wilkes RP, Kilpad DV, Zhao Y, et al. Closed incision management with negative pressure wound therapy (CIM) biomechanics. Surg Innovat. 2012;19(1):67–75.CrossRef
29.
Varela JE, Wilson SE, Nguyen NT. Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc. 2010;24:270–6.CrossRefPubMed
30.
Nguyen NT, Goldman CD, Ho HS, et al. Systemic stress response after laparoscopic and open gastric bypass. J Am Coll Surg. 2002;194(5):557–66.CrossRefPubMed
31.
Wichmann MW, Hüttl TP, Winter H, et al. Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study. Arch Surg. 2005;140(7):692–7.CrossRefPubMed
32.
Whelan R, Franklin M, Holubar S, et al. Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc. 2003;17(6):972.CrossRefPubMed
33.
Mohiuddin K, Swanson SJ. Maximizing the benefit of minimally invasive surgery. J Surg Oncol. 2013;108(5):315–9.CrossRefPubMed
34.
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(6):1082–6.CrossRefPubMed
35.
Perencevich EN, Sands KE, Cosgrove SE, et al. Health and economic impact of surgical site infections diagnosed after hospital discharge. Emerg Infect Dis. 2003;9(2):196–203.CrossRefPubMedPubMedCentral
36.
Foster JM, Sleightholm R, Patel A, et al. Morbidity and mortality rates following cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy compared with other high-risk surgical oncology procedures. JAMA Netw Open. 2019;2(1):e186847.CrossRefPubMedPubMedCentral
37.
Othman D. Negative pressure wound therapy literature review of efficacy, cost effectiveness, and impact on patients' quality of life in chronic wound management and its implementation in the United kingdom. Plast Surg Int. 2012.
Metadata
Title
Negative Pressure Wound Therapy to Reduce Surgical Site Infections after CRS/HIPEC
Authors
Kylie J. Nabata, MD
Sabrina Rai
Darren Zhao
Andrea J. MacNeill, MD
Trevor D. Hamilton, MD
Publication date
23-04-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15283-z