Prophylactic effect of negative‐pressure wound therapy and delayed sutures against incisional‐surgical site infection after emergency laparotomy for colorectal perforation: A multicenter retrospective cohort study

Abstract

Aim The prophylactic effect of negative‐pressure wound therapy against incisional surgical site infection after highly contaminated laparotomies has not been sufficiently explored. This study aimed to evaluate the prophylactic effect of negative‐pressure wound therapy against incisional surgical site infection after emergency surgery for colorectal perforation. Methods This nationwide, multicenter, retrospective cohort study analyzed data from the 48 emergency hospitals certificated by the Japanese Society for Abdominal Emergency Medicine. Patients who underwent an emergency laparotomy for colorectal perforation between April 2015 and March 2020 were included in this study. Outcomes, including the incidence of incisional surgical site infection, were compared between patients who were treated with prophylactic negative‐pressure wound therapy and delayed sutures (i.e., negative‐pressure wound therapy group) and patients who were treated with regular wound management (i.e., control group) using 1:4 propensity score matching analysis. Results The negative‐pressure wound therapy group comprised 88 patients, whereas the control group consisted of 1535 patients. Of them, 82 propensity score‐matched pairs (negative‐pressure wound therapy group: 82; control group: 328) were evaluated. The negative‐pressure wound therapy group showed a lower incidence of incisional surgical site infection [18 (22.0%) in the negative‐pressure wound therapy group and 115 (35.0%) in the control group, odds ratio, 0.52; 95% confidence interval, 0.30 to 0.92; p = 0.026]. Conclusions The prophylactic use of negative‐pressure wound therapy with delayed sutures was associated with a lower incidence of incisional surgical site infection after emergency surgery for colorectal perforation.

How to interpret the results of clinical studies: “Multicenter cutting‐edge study” or “real‐world big data study”?

“… 1 By a multicenter retrospective cohort study of 1,623 patients followed by propensity score matching (PSM), Nakatsutsumi et al have revealed that the prophylactic use of negative‐pressure wound therapy with delayed sutures was associated with a lower incidence of incisional surgical site infection after emergency laparotomy for colorectal perforation. 2 If the number of subjects is large, PSM can be used to adjust background factors and obtain reliable results with scientifically valid analyses. Noda et al have demonstrated that neoadjuvant chemotherapy for resectable colorectal liver metastasis might prolong the recurrence‐free survival period in 192 patients with intermediate risk of postoperative recurrence by data analysis of 20 institutions with PSM (DOI:10.1002/ags3.12643).…”

“…Umeda et al have proposed the appropriate extent of lymphadenectomy in surgery for intrahepatic cholangiocarcinoma according to tumor location, by a multicenter data analysis of the therapeutic index of 279 patients (DOI:10.1002/ags3.12631) 1 . By a multicenter retrospective cohort study of 1,623 patients followed by propensity score matching (PSM), Nakatsutsumi et al have revealed that the prophylactic use of negative‐pressure wound therapy with delayed sutures was associated with a lower incidence of incisional surgical site infection after emergency laparotomy for colorectal perforation 2 . If the number of subjects is large, PSM can be used to adjust background factors and obtain reliable results with scientifically valid analyses.…”