Evaluation of Incisional Negative Pressure Wound Therapy in the Prevention of Surgical Site Occurrences After Radical Cystectomy: A New Addition to Enhanced Recovery After Surgery Protocol.
Enhanced recovery
Outcomes
Radical cystectomy
Surgical site infection
Journal
European urology focus
ISSN: 2405-4569
Titre abrégé: Eur Urol Focus
Pays: Netherlands
ID NLM: 101665661
Informations de publication
Date de publication:
15 07 2020
15 07 2020
Historique:
received:
10
04
2019
revised:
16
08
2019
accepted:
24
09
2019
pubmed:
11
11
2019
medline:
21
5
2021
entrez:
10
11
2019
Statut:
ppublish
Résumé
Surgical site infection (SSI) remains a significant complication after radical cystectomy (RC). Enhanced recovery after surgery (ERAS) focuses on interventions to decrease length of stay, but few address wound-related complications directly. To determine the impact that prophylactic incisional negative pressure wound therapy (iNPWT) will have to reduce the rate of surgical site occurrences (SSOs = SSI + seroma + superficial dehiscence) after RC. We retrospectively reviewed patients undergoing RC by a single surgeon from 2012 to 2017. As part of our ERAS pathway, we employed prophylactic iNPWT during abdominal closure and compared it with a contemporary cohort of standard wound closure. We compared 90-d SSIs, SSOs, and readmissions between iNPWT and standard skin staple closure. Univariate and multivariate regressions were used to compare the two groups. We identified 158 (104 iNPWT, 54 standard) patients from 2012 to 2017. The rates of SSIs and SSOs were 9.7% and 19.0%, respectively. The overall readmission rate for the cohort was 21.5%, with 4.4% of patients requiring readmission for SSI. The iNPWT group had lower rates of SSIs (5.8% vs 16.7%, p = 0.03) and SSOs (11.5% vs 33.3%, p < 0.01). There was no difference between the groups for readmission (21.1% vs 22.2%, p = 0.5). The iNPWT protected against both SSI (odds ratio [OR] 0.89, 95% confidence interval [CI]: 0.81-0.98) and 90-d SSO (OR 0.77, 95% CI: 0.68-0.87). Prophylactic iNPWT is feasible after RC with a modest decrease in both 90-d SSIs and 90-d SSOs, but not readmissions. Wound closure assisted by iNPWT should be considered in RC ERAS pathways. In this report, we looked at the impact of new vacuum suction dressing on the prevention of surgical infections after radical cystectomy (RC). We found that this wound dressing can decrease the impact of surgical infections and aid in recovery after RC.
Sections du résumé
BACKGROUND
Surgical site infection (SSI) remains a significant complication after radical cystectomy (RC). Enhanced recovery after surgery (ERAS) focuses on interventions to decrease length of stay, but few address wound-related complications directly.
OBJECTIVE
To determine the impact that prophylactic incisional negative pressure wound therapy (iNPWT) will have to reduce the rate of surgical site occurrences (SSOs = SSI + seroma + superficial dehiscence) after RC.
DESIGN, SETTINGS, AND PARTICIPANTS
We retrospectively reviewed patients undergoing RC by a single surgeon from 2012 to 2017. As part of our ERAS pathway, we employed prophylactic iNPWT during abdominal closure and compared it with a contemporary cohort of standard wound closure.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
We compared 90-d SSIs, SSOs, and readmissions between iNPWT and standard skin staple closure. Univariate and multivariate regressions were used to compare the two groups.
RESULTS AND LIMITATIONS
We identified 158 (104 iNPWT, 54 standard) patients from 2012 to 2017. The rates of SSIs and SSOs were 9.7% and 19.0%, respectively. The overall readmission rate for the cohort was 21.5%, with 4.4% of patients requiring readmission for SSI. The iNPWT group had lower rates of SSIs (5.8% vs 16.7%, p = 0.03) and SSOs (11.5% vs 33.3%, p < 0.01). There was no difference between the groups for readmission (21.1% vs 22.2%, p = 0.5). The iNPWT protected against both SSI (odds ratio [OR] 0.89, 95% confidence interval [CI]: 0.81-0.98) and 90-d SSO (OR 0.77, 95% CI: 0.68-0.87).
CONCLUSIONS
Prophylactic iNPWT is feasible after RC with a modest decrease in both 90-d SSIs and 90-d SSOs, but not readmissions. Wound closure assisted by iNPWT should be considered in RC ERAS pathways.
PATIENT SUMMARY
In this report, we looked at the impact of new vacuum suction dressing on the prevention of surgical infections after radical cystectomy (RC). We found that this wound dressing can decrease the impact of surgical infections and aid in recovery after RC.
Identifiants
pubmed: 31704281
pii: S2405-4569(19)30292-5
doi: 10.1016/j.euf.2019.09.016
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
698-703Informations de copyright
Copyright © 2019. Published by Elsevier B.V.