Negative pressure wound therapy in spinal fusion patients

Abstract

Post-operative wound complications are some of the most common acute complications following spine surgery. These surgical site infections (SSI) contribute to increased healthcare related costs. Negative pressure wound therapy (NPWT) has long been used for treatment of soft tissue injury or defects. NPWT may reduce the incident of SSI following spinal fusion procedures; however, its potential applications need further clarification. Thus, we conducted a retrospective analysis of two cohorts to compare NPWT to traditional sterile dressings following spinal fusions in regards to post-operative outcomes. Following institutional review board approval, 42 patients who had a NPWT were matched by type of surgery to 42 patients who had traditional dressings. A retrospective chart-review was completed. Outcome measures, particularly SSI and need for reoperation, were analyzed using one-way ANOVA for both univariate and multivariate analysis. When controlled for sex and body-mass index, the use of a NPWT was independently correlated with decreased SSI (P = .035). Superficial dehiscence, seroma, need for additional outpatient care, and need for operative revision were all found to occur at higher rates in the traditional dressing cohort. Closed incisional negative pressure wound therapy provides a cost-effective method of decreasing surgical site infection for posterior elective spine surgeries.

Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

“…The 84 studies identified encompassed cardiac surgery (n = 8), general abdominal surgery (n = 21), obstetric and gynecologic surgery (n = 8), orthopedic surgery (n = 16), plastic surgery (n = 16), and vascular surgery (n = 15). 11–16,20–97…”

“…Dressings used in the SOC population varied and included gauze dressings, antimicrobial hydrofiber dressings, absorbent dressings, hydrocolloid dressings, occlusive dressings, or foam dressings. 11–16,20–97…”

“…The included studies represent a global surgical patient population with 7451 patients receiving ciNPT and 16,085 patients receiving SOC across 16 countries. 11–16,20–97 The countries represented included the USA (n = 42), Germany (n = 11), Australia (n = 6), Canada (n = 5), Italy (n = 4), Spain (n = 3), the UK (n = 3), Denmark (n = 2), and one each from Austria, Brazil, France, Ireland, the Netherlands, South Africa, Taiwan, and Turkey. Dressings used in the SOC population varied and included gauze dressings, antimicrobial hydrofiber dressings, absorbent dressings, hydrocolloid dressings, occlusive dressings, or foam dressings.…”

Negative Pressure Wound Therapy in Spinal Surgery

“…However, this finding was not statistically significant, likely owing to the small sample size [ 57 ]. A 2021 retrospective matched cohort study demonstrated that Prevena NPWT is associated with reduced incidence of SSI when controlling for sex and BMI in patients undergoing posterior spinal fusions [ 58 ]. However, the control cohort in this study had an unusually high incidence of SSI (7.1% or 3 out of 42 patients) [ 58 ].…”

“…A 2021 retrospective matched cohort study demonstrated that Prevena NPWT is associated with reduced incidence of SSI when controlling for sex and BMI in patients undergoing posterior spinal fusions [ 58 ]. However, the control cohort in this study had an unusually high incidence of SSI (7.1% or 3 out of 42 patients) [ 58 ]. A 2021 retrospective, non-randomized study of a small patient population showed that the use of NPWT in patients with metastatic spine disease and instability or accelerated neurological decline resulted in reduced incidence of SSI postoperatively, which is important given the high risk of wound complications in this population [ 59 ].…”