S116: Impact of incisional negative pressure wound therapy on surgical site infection after complex incisional hernia repair: a retrospective matched ... View Full Text


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Article Info

DATE

2020-08-06

AUTHORS

Brent Hopkins, Jules Eustache, Olivia Ganescu, Josie Cipolla, Pepa Kaneva, Gerald M. Fried, Kosar Khwaja, Melina Vassiliou, Paola Fata, Lawrence Lee, Liane S. Feldman

ABSTRACT

IntroductionIncisional negative pressure wound therapy (iNPWT) may reduce surgical site infections (SSI), which can have devastating consequences after incisional hernia repair. Few comparative studies investigate the effectiveness of this wound management strategy in this population. The objective of this study is to determine the effect of iNPWT on the incidence of SSI after complex incisional hernia repair.MethodsAll adult patients undergoing open incisional hernia repair at a single center from 2016 to 2019 were reviewed. A commercial iNPWT dressing was used at the discretion of the surgeon. Patients were grouped by type of dressing; iNPWT and standard sterile dressings (SSD). Coarsened exact matching was used to create balanced cohorts for comparison using age, sex, American Society of Anesthesiologists classification, wound classification, and surgical urgency. The primary outcome was the composite incidence of superficial and deep SSI within 30 days. Secondary outcomes included non-infectious surgical site occurrences (SSO), overall complications, length of stay (LOS), emergency department visits, and readmission at 30 days.Results134 patients underwent complex hernia repair, with 114 patients included after matching (34 iNPWT, 51 SSD). Composite incidence of superficial and deep SSI was 19.3% (11.8% vs. 27.5%, p = 0.107), with significantly lower rates of deep SSI in patients receiving iNPWT (2.9% vs. 17.6%, p = 0.045). After accounting for residual differences between groups, iNPWT was associated with decreased incidence of composite SSI (RR 0.36, 95% CI [0.16, 0.87]). Median LOS was longer in patients with iNPWT (7 vs. 5 days, p = 0.001). There were no differences in SSO, overall complications, readmission, or emergency department visits.ConclusionIn patients undergoing incisional hernia repair, the use of iNPWT was associated with a lower incidence of SSI at 30 days. Future studies should focus on cost effectiveness of iNPWT, its impact on long-term hernia recurrences, and the identification of patient selection criteria in this population. More... »

PAGES

3949-3960

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00464-020-07857-1

DOI

http://dx.doi.org/10.1007/s00464-020-07857-1

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1129936674

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/32761478


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    "description": "IntroductionIncisional negative pressure wound therapy (iNPWT) may reduce surgical site infections (SSI), which can have devastating consequences after incisional hernia repair. Few comparative studies investigate the effectiveness of this wound management strategy in this population. The objective of this study is to determine the effect of iNPWT on the incidence of SSI after complex incisional hernia repair.MethodsAll adult patients undergoing open incisional hernia repair at a single center from 2016 to 2019 were reviewed. A commercial iNPWT dressing was used at the discretion of the surgeon. Patients were grouped by type of dressing; iNPWT and standard sterile dressings (SSD). Coarsened exact matching was used to create balanced cohorts for comparison using age, sex, American Society of\u00a0Anesthesiologists classification, wound classification, and surgical urgency. The primary outcome was the composite incidence of superficial and deep SSI within 30\u00a0days. Secondary outcomes included non-infectious surgical site occurrences (SSO), overall complications, length of stay (LOS), emergency department visits, and readmission at 30\u00a0days.Results134 patients underwent complex hernia repair, with 114 patients included after matching (34 iNPWT, 51 SSD). Composite incidence of superficial and deep SSI was 19.3% (11.8% vs. 27.5%, p\u2009=\u20090.107), with significantly lower rates of deep SSI in patients receiving iNPWT (2.9% vs. 17.6%, p\u2009=\u20090.045). After accounting for residual differences between groups, iNPWT was associated with decreased incidence of composite SSI (RR 0.36, 95% CI [0.16, 0.87]). Median LOS was longer in patients with iNPWT (7 vs. 5\u00a0days, p\u2009=\u20090.001). There were no differences in SSO, overall complications, readmission, or emergency department visits.ConclusionIn patients undergoing incisional hernia repair, the use of iNPWT was associated with a lower incidence of SSI at 30\u00a0days. Future studies should focus on cost effectiveness of iNPWT, its impact on long-term hernia recurrences, and the identification of patient selection criteria in this population.", 
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22 schema:description IntroductionIncisional negative pressure wound therapy (iNPWT) may reduce surgical site infections (SSI), which can have devastating consequences after incisional hernia repair. Few comparative studies investigate the effectiveness of this wound management strategy in this population. The objective of this study is to determine the effect of iNPWT on the incidence of SSI after complex incisional hernia repair.MethodsAll adult patients undergoing open incisional hernia repair at a single center from 2016 to 2019 were reviewed. A commercial iNPWT dressing was used at the discretion of the surgeon. Patients were grouped by type of dressing; iNPWT and standard sterile dressings (SSD). Coarsened exact matching was used to create balanced cohorts for comparison using age, sex, American Society of Anesthesiologists classification, wound classification, and surgical urgency. The primary outcome was the composite incidence of superficial and deep SSI within 30 days. Secondary outcomes included non-infectious surgical site occurrences (SSO), overall complications, length of stay (LOS), emergency department visits, and readmission at 30 days.Results134 patients underwent complex hernia repair, with 114 patients included after matching (34 iNPWT, 51 SSD). Composite incidence of superficial and deep SSI was 19.3% (11.8% vs. 27.5%, p = 0.107), with significantly lower rates of deep SSI in patients receiving iNPWT (2.9% vs. 17.6%, p = 0.045). After accounting for residual differences between groups, iNPWT was associated with decreased incidence of composite SSI (RR 0.36, 95% CI [0.16, 0.87]). Median LOS was longer in patients with iNPWT (7 vs. 5 days, p = 0.001). There were no differences in SSO, overall complications, readmission, or emergency department visits.ConclusionIn patients undergoing incisional hernia repair, the use of iNPWT was associated with a lower incidence of SSI at 30 days. Future studies should focus on cost effectiveness of iNPWT, its impact on long-term hernia recurrences, and the identification of patient selection criteria in this population.
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29 schema:keywords American Society
30 Anesthesiologists classification
31 ConclusionIn patients
32 MethodsAll adult patients
33 Secondary outcomes
34 adult patients
35 age
36 balanced cohort
37 center
38 classification
39 cohort
40 cohort study
41 commercial
42 comparative study
43 comparison
44 complex hernia repair
45 complex incisional hernia repair
46 complications
47 composite incidence
48 consequences
49 cost effectiveness
50 criteria
51 days
52 decreased incidence
53 deep surgical site infection
54 department visits
55 devastating consequences
56 differences
57 discretion
58 dressing
59 effect
60 effectiveness
61 emergency department visits
62 exact matching
63 future studies
64 group
65 hernia
66 hernia repair
67 identification
68 impact
69 incidence
70 incidence of SSI
71 incisional hernia repair
72 incisional negative pressure
73 infection
74 length
75 length of stay
76 lower incidence
77 lower rates
78 management strategies
79 matching
80 median LOS
81 negative pressure
82 negative pressure wound therapy
83 objective
84 occurrence
85 open incisional hernia repair
86 outcomes
87 overall complications
88 patient selection criteria
89 patients
90 population
91 pressure
92 pressure wound therapy
93 primary outcome
94 rate
95 readmission
96 repair
97 residual differences
98 selection criteria
99 sex
100 single center
101 site infection
102 site occurrence
103 society
104 standard sterile dressing
105 stay
106 sterile dressing
107 strategies
108 study
109 surgeons
110 surgical site infection
111 surgical site occurrence
112 surgical urgency
113 therapy
114 types
115 types of dressings
116 urgency
117 use
118 visits
119 wound management strategies
120 wound therapy
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