Prophylactic negative pressure wound therapy in colorectal surgery. Effects on surgical site events: current status and call to action

Abstract

Surgical site events, including surgical site infections (SSI), represent a major problem in general surgery. SSI are responsible of nuisance for patients, and can lead to important complications and disability, often needing prolonged postoperative stay with specific treatment and recovery in Intensive Care Units. These justify the higher costs due to SSI. Despite the growing body of evidence concerning SSI in general surgery, literature dealing with SSI after colorectal surgery is scarce, reflecting in suboptimal perception of such a relevant issue by colorectal surgeons and health authorities in Italy, though colorectal surgery is associated with higher rates of SSI. The best strategy for reducing the impact of SSI on costs of care and patients quality of life would be the development of a preventive bundle, similar to that adopted in the US through the colorectal section of the National Surgery Quality Improvement Project of the American College of Surgeons (ACS-NSQIP). This policy has been showed to significantly reduce the rates of SSI. In this scenario, incisional negative pressure wound therapy (NPWT) is likely to play a pivotal role. We herein reviewed the literature to report on the current status of preventive NPWT on surgical wounds of patients undergoing colorectal procedures with primary wound closure, suggesting evidence-based measures to reduce the impact of SSI, and to contain the costs associated with conventional NPWT devices by means of newer available technologies. Some explicative real life cases are presented.

Closed incision negative pressure therapy: international multidisciplinary consensus recommendations

“…Despite the small number of ciNPT studies, in comparison to the large number on NPWT, current literature supports its benefit in high‐risk patients and incisions. A majority of the 100 publications reported decreased rates of SSIs, dehiscence and haematoma/seroma formation . A recent meta‐analysis reported a 50% reduction in the rate of SSIs in the ciNPT group compared with the control group (OR 0·564; P < 0·00001) .…”

Ten‐year analyses of the German DRG data about negative pressure wound therapy

“…• in 2014, 50% of all cases hospitalised for stage IV pressure ulcer at sacrum or ischium and around one third (32⋅2%) of cases with pyothorax received NPWT; every fourth to fifth case hospitalised for disruption of surgical wounds or infections following a procedure (24.1%), as well as for infections and inflammations because of internal joint prosthesis or an internal fixation device, was treated with NPWT (22⋅9%), and in cases with diabetic foot syndrome, it is still every tenth case (10⋅1%) adopted for a broad range of indications in acute and chronic wounds (1)(2)(3)(4)(5)(6)(7)(8)(9). There is some evidence to suggest that NPWT is more effective in healing post-surgical foot wounds and ulcers of the foot in people with diabetes mellitus compared with moist wound dressings (4,8).…”

“…The mechanism by which NPWT is thought to promote wound healing is through increasing local perfusion, eliminating tissue oedema, drawing wound edges together, removing exudates and proinflammatory cytokines, inhibiting bacterial growth and promoting cell hyperplasia. NPWT systems have been widely adopted for a broad range of indications in acute and chronic wounds .…”

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

“…Some authors have advocated the inclusion of negative-pressure wound therapy (NPWT) to SSI bundles, based on preliminary evidence of its efficacy in the prevention of SSIs on closed laparotomy incisions. 15 …”