Prophylactic Use of Negative Pressure Wound Therapy After Cesarean Delivery

Echebiri, Nelson C.; McDoom, M. Maya; Aalto, M.; Fauntleroy, J.; Nagappan, N.; Barnabei, Vanessa M.

doi:10.1097/aog.0000000000000634

Cited by 41 publications

(17 citation statements)

References 36 publications

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“…Three studies on cost effectiveness in a gynecologic population have been performed. [ 44 – 46 ] Their results show a potential for pNPWT to be cost effective, especially in patient groups with high risk of SSI, such as clean-contaminated operations, or operations performed upon patients with intrinsic risk factors, such as obesity, diabetes, or immunosuppressive medication.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery

et al. 2016

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Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery

et al. 2016

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“…Retrospective studies of prophylactic negative pressure wound therapy after CD in morbidly obese women, however, demonstrated fewer wound complications [61, 62]. A cost-benefit analysis showed that negative pressure wound therapy is only beneficial if the risk of surgical site infection is greater than 14% [63]. A large randomized controlled trials comparing prophylactic negative pressure wound therapy with standard dressing in women with obesity would be useful.…”

Section: Intraoperative Managementmentioning

confidence: 99%

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

Kawakita

Landy

2017

matern health, neonatol and perinatol

168

105

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Cesarean delivery (CD) is one of the most common procedures performed in the United States, accounting for 32% of all deliveries. Postpartum surgical site infection (SSI), wound infection and endometritis is a major cause of prolonged hospital stay and poses a burden to the health care system. SSIs complicate a significant number of patients who undergo CD – 2-7% will experience sound infections and 2-16% will develop endometritis. Many risk factors for SSI have been described. These include maternal factors (such as tobacco use; limited prenatal care; obesity; corticosteroid use; nulliparity; twin gestations; and previous CD), intrapartum and operative factors (such as chorioamnionitis; premature rupture of membranes; prolonged rupture of membranes; prolonged labor, particularly prolonged second stage; large incision length; subcutaneous tissue thickness > 3 cm; subcutaneous hematoma; lack of antibiotic prophylaxis; emergency delivery; and excessive blood loss), and obstetrical care on the teaching service of an academic institution. Effective interventions to decrease surgical site infection include prophylactic antibiotic use (preoperative first generation cephalosporin and intravenous azithromycin), chlorhexidine skin preparation instead of iodine, hair removal using clippers instead of razors, vaginal cleansing by povidone-iodine, placental removal by traction of the umbilical cord instead of by manual removal, suture closure of subcutaneous tissue if the wound thickness is >2 cm, and skin closure with sutures instead of with staples. Implementation of surgical bundles in non-obstetric patients has been promising., Creating a similar patient care bundle comprised evidence-based elements in patients who undergo CD may decrease the incidence of this major complication. Each hospital has the opportunity to create its own CD surgical bundle to decrease surgical site infection.

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“…On the other hand, pNPWT also incurs additional costs. We identified three studies [25–27] on cost-effectiveness of pNPWT and these were all performed in a gynaecological population. Lewis et al [26] found that the risk of wound complications must be reduced by 33% for pNPWT to achieve cost savings.…”

Section: Discussionmentioning

confidence: 99%

“…For obese and morbid obese patients, required reduction was slightly less. Echebiri et al [25] concluded that if surgical site infection rates are greater than 14%, pNPWT could be cost-beneficial depending on the degree of reduction in surgical site infections. At a surgical site infection rate of 30%, the rate must be reduced by 15% for pNPWT to become the preferred strategy.…”

Section: Discussionmentioning

confidence: 99%

Closed incision prophylactic negative pressure wound therapy in patients undergoing major complex abdominal wall repair

Vries

Atema

Lapid

et al. 2017

Hernia

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PurposeTo evaluate if incisional prophylactic negative pressure wound therapy (pNPWT) reduces wound infections and other wound complications in high-risk patients undergoing major complex ventral abdominal wall repair.MethodsRetrospective before–after comparison nested in a consecutive series of patients undergoing elective major complex abdominal wall repair. Starting January 2014, pNPWT was applied on the closed incisional wound for a minimum of 5 days. To minimize selection bias, we compared two periods of 14 months before and after January 2014. Wound infections according to the Centre for Disease Control Surgical Site Infection classification as well as other wound complications were recorded.ResultsThirty-two patients were included in the pNPWT group and 34 in the control group. The study group involved clean-contaminated and contaminated operations due to enterocutaneous fistula, enterostomies or infected mesh. Median duration of pNPWT was 5 days (IQR 5–7). Overall wound infection rate was 35%. pNPWT was associated with a significant decrease in postoperative wound infection rate (24 versus 51%; p = 0.029, OR 0.30 (95% CI 0.10–0.90)). Incisional wound infection rates dropped from 48 to 7% (p < 0.01, OR 0.08 (95% CI 0.16–0.39), whereas the number of subcutaneous abscesses was comparable in both groups. Moreover, less interventions were needed in the pNPWT group (p < 0.001).ConclusionsClosed incision pNPWT seems a promising solution to reduce the incidence of wound infections in complex abdominal wall surgery. Randomized controlled trials are needed to estimate more precisely the value and cost-effectiveness of pNPWT in this high-risk setting.

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Prophylactic Use of Negative Pressure Wound Therapy After Cesarean Delivery

Cited by 41 publications

References 36 publications

A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery

A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery

Surgical site infections after cesarean delivery: epidemiology, prevention and treatment

Closed incision prophylactic negative pressure wound therapy in patients undergoing major complex abdominal wall repair

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