Utilizing Closed Incisional Negative Pressure Therapy Reduces Peripheral Bypass Infection Rates Without Increasing Costs

Abstract

Introduction: We evaluated outcomes of closed incisional negative pressure therapy (ciNPT) on surgical site infection (SSI) rates in lower extremity bypass patients. We sought to determine whether or not the routine use of ciNPT is a cost-effective measure. Methods: During a period from May 2018 to August 2018, our institution transitioned to the routine use of ciNPT for re-vascularization procedures. We retrospectively reviewed our outcomes before and after the initiation of ciNPT. Group A included patients from September 2017 to April 2018 without ciNPT and Group B included patients from September 2018 to April 2019 with ciNPT. Chi-squared analysis was performed and the p value was set at <0.05 to obtain statistical significance. Cost analysis was separately performed utilizing hospital metrics. Results: There were a total of 102 patients in Group A and 113 patients in Group B. There was no difference in demographic information between the two groups. The overall SSI rate for Group A was 11.8% (12/102). Group B had an overall SSI rate of 3.5% (4/113; p=0.02). Deep infection rate for Group A was 7% (7/102) and for Group B was 1% (1/113; p=0.01). Cost analysis demonstrated a minimum of $62,000 in infection-related cost savings between both groups. Conclusions: ciNPT has had a profound effect on our practice and has resulted in a decrease in both deep and superficial infections. This has led to a significant cost-effective measure for our institution. We now routinely use ciNPT on all lower extremity bypass patients.

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

“…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.…”

“…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…”

Postoperative Wundinfektionen

“…Dabei erzielten die analysierten RCTs eine signifikante Reduktion der postoperativen Wundinfektionsrate um 5 bis 8 Prozentpunkte und die Metaanalyse von Saunders et al identifizierte eine "Number needed to treat" von 20 [4,34]. Spezifisch für gefäßchirurgische Zugangswege und Operationen konnten aktuelle Studien und Metaanalysen mit signifikanter Reduktion der postoperativen Wundinfektionsrate für Leistenzugänge [5,18], periphere Bypasschirurgie [13], Majoramputationen [6] und generell vaskuläre Chirurgie [35,42] aus den letzten drei Jahren identifiziert werden. Hinsichtlich weiterer postoperativer Wundkomplikationen (z.…”