Closed Incision Negative Pressure Therapy Achieves Better Outcome Than Standard Wound Care: Clinical Outcome and Cost-Effectiveness Analysis in Open Ventral Hernia Repair With Synthetic Mesh Positioning

Abstract

Background Surgical site infections (SSIs) and surgical site occurrences (SSOs) are frequent post-operative complications that are dependent on the presence of different risk factors. The use of closed incision negative pressure therapy (ciNPT) is considered a measure by the WHO guidelines for prevention of SSIs. The prevention of SSOs is an extremely important issue in the ventral hernia repair (VHR) surgical field. SSO onset not only affects the patient's quality of life, but can also cause the onset of life-threatening conditions that may require re-hospitalization, reintervention and often mesh removal. Such outcome can become extremely costly, contributing to increased health care costs for the patient as well as the hospital. This study aims (1) to describe the epidemiological characteristics of SSOs following VHR in our experience; (2) to compare the post-operative outcomes of those who underwent VHR with synthetic mesh when treated with standard wound care (SWC) using gauze dressings vs ciNPT, and finally (3) to perform a spending review of the ciNPT in the hypothesis of its application after VHR with use of synthetic prosthetic material; financial savings including cost-effectiveness were investigated in terms of prevention of wound complications.

The European Hernia Society Prehabilitation Project: A Systematic Review of Intra-Operative Prevention Strategies for Surgical Site Occurrences in Ventral Hernia Surgery

“…Eight papers were identified in this review that exclusively addressed prophylactic incisional (closed-wound) negative pressure wound therapy after ventral hernia repair. One had to be discarded because a full text was not found (27)(28)(29)(30)(31)(32)(33). All studies seem consistent in reporting lower rates of SSI and SSO when using pNPWT (Table 3).…”

Evidence-Based Strategies to Promote Long-Term Cardiac Implant Site Health: Review of the Literature

“…The administration of hemostatic agents in the surgical pocket improves postoperative healing reducing the hematoma formation rate. The use of closed incision negative pressure systems (ciNPTs) helps prevent SSIs and CIEDs removal [ 23 ].…”

“…Removal of an infected CIED can be performed either by percutaneous lead traction through the generator pocket or by a surgical approach [ 34 ]. The use of advanced medications, such as ciNPT and vacuum-assisted closure (VAC) therapy, can be considered to improve healing [ 23 ].…”

How Can Negative Pressure Wound Therapy Pay for Itself?—Reducing Complications Is Important

“…11 The use of incisional negative pressure wound therapy (iNPWT) reduces the risk of SSI in multiple specialties, including colorectal surgery, vascular surgery, and plastic surgery. [12][13][14][15][16][17][18] A systematic review and meta-analysis of studies comparing iNPWT with the standard of care in the reduction of SSIs demonstrated a statistically significant reduction in SSI for all 7 subgroup analyses conducted. 19 In orthopaedic surgery, iNPWT reduces the risk of SSI in lower extremity fractures, primary and revision arthroplasty, hip and knee periprosthetic fractures, and hemiarthroplasty following femoral neck fractures.…”