Effects of Negative Pressure Wound Therapy on Wound Dehiscence and Surgical Site Infection Following Instrumented Spinal Fusion Surgery-A Single Surgeon's Experience.
Aged
Case-Control Studies
Cohort Studies
Discitis
/ surgery
Dura Mater
/ surgery
Female
Humans
Lumbar Vertebrae
/ surgery
Male
Middle Aged
Negative-Pressure Wound Therapy
/ statistics & numerical data
Osteomyelitis
/ surgery
Patient Readmission
/ statistics & numerical data
Reoperation
/ statistics & numerical data
Retrospective Studies
Risk Factors
Spinal Fusion
/ methods
Spinal Neoplasms
/ surgery
Surgical Wound Dehiscence
/ epidemiology
Surgical Wound Infection
/ epidemiology
NPWT
Prevention
Spine fusion
Surgical wound complications
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
01
11
2019
revised:
18
01
2020
accepted:
20
01
2020
pubmed:
1
2
2020
medline:
15
8
2020
entrez:
1
2
2020
Statut:
ppublish
Résumé
Incisional negative pressure wound therapy (NPWT) is used in many surgical specialties to prevent postoperative dehiscence and surgical site infections (SSIs). However, little is known about the role of incisional NPWT in spine fusion surgery. Therefore, we sought to report a single surgeon's experience using incisional NPWT and describe its effects on dehiscence and SSIs after instrumented spine surgery. We compared rates of hospital readmission and return to the operating room for dehiscence and SSIs in a consecutive series of patients who underwent spinal fusion surgery with or without NPWT from 2015 to 2018. A total of 393 patients without and 76 patients with NPWT were included for analysis. Half way through the data collection period, all patients who underwent anterior lumbar fusion received NPWT. Three of 15 (20.0%) of non-NPWT patients who underwent anterior lumbar fusion had dehiscence or SSI compared with zero of 23 (0.0%) of NPWT patients (P = 0.01). NPWT for posterior surgeries was used on a case-by-case basis using risk factors that contribute to SSIs and dehiscence. NPWT patients had higher rates of spinal neoplasia (0.5% vs. 11.3%, P < 0.0001), osteomyelitis/diskitis (1.3% vs. 7.5%, P = 0.02), durotomy (14.9% vs. 28.6%, P = 0.007), revision surgery (32.2% vs. 59.6%, P = 0.0001), and longer fusion constructs (7 vs. 11 levels, P < 0.0001) but had similar rates of dehiscence and SSIs as non-NPWT patients (5.6% vs. 5.7%, P = 0.98). NPWT decreases dehiscence and SSIs in patients undergoing lumbar fusion through an anterior approach. When preferentially used in patients at high risk for postoperative wound complications, NPWT prevents increased rates of dehiscence and SSI.
Sections du résumé
BACKGROUND
Incisional negative pressure wound therapy (NPWT) is used in many surgical specialties to prevent postoperative dehiscence and surgical site infections (SSIs). However, little is known about the role of incisional NPWT in spine fusion surgery. Therefore, we sought to report a single surgeon's experience using incisional NPWT and describe its effects on dehiscence and SSIs after instrumented spine surgery.
METHODS
We compared rates of hospital readmission and return to the operating room for dehiscence and SSIs in a consecutive series of patients who underwent spinal fusion surgery with or without NPWT from 2015 to 2018.
RESULTS
A total of 393 patients without and 76 patients with NPWT were included for analysis. Half way through the data collection period, all patients who underwent anterior lumbar fusion received NPWT. Three of 15 (20.0%) of non-NPWT patients who underwent anterior lumbar fusion had dehiscence or SSI compared with zero of 23 (0.0%) of NPWT patients (P = 0.01). NPWT for posterior surgeries was used on a case-by-case basis using risk factors that contribute to SSIs and dehiscence. NPWT patients had higher rates of spinal neoplasia (0.5% vs. 11.3%, P < 0.0001), osteomyelitis/diskitis (1.3% vs. 7.5%, P = 0.02), durotomy (14.9% vs. 28.6%, P = 0.007), revision surgery (32.2% vs. 59.6%, P = 0.0001), and longer fusion constructs (7 vs. 11 levels, P < 0.0001) but had similar rates of dehiscence and SSIs as non-NPWT patients (5.6% vs. 5.7%, P = 0.98).
CONCLUSIONS
NPWT decreases dehiscence and SSIs in patients undergoing lumbar fusion through an anterior approach. When preferentially used in patients at high risk for postoperative wound complications, NPWT prevents increased rates of dehiscence and SSI.
Identifiants
pubmed: 32004742
pii: S1878-8750(20)30170-4
doi: 10.1016/j.wneu.2020.01.152
pmc: PMC8063507
mid: NIHMS1686118
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e257-e262Subventions
Organisme : NIGMS NIH HHS
ID : T32 GM065841
Pays : United States
Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.
Références
J Neurosurg Spine. 2007 May;6(5):407-11
pubmed: 17542505
J Am Coll Surg. 2019 Apr;228(4):393-397
pubmed: 30586643
Spine (Phila Pa 1976). 2018 May 15;43(10):732-737
pubmed: 28922276
J Orthop Case Rep. 2017 Jan-Feb;7(1):95-100
pubmed: 28630851
Spine (Phila Pa 1976). 2017 Dec 15;42(24):1865-1870
pubmed: 28549000
Spine J. 2014 Dec 1;14(12):2911-7
pubmed: 24769401
Curr Rev Musculoskelet Med. 2016 Sep;9(3):327-32
pubmed: 27278531
Bone Joint Res. 2013 Dec 18;2(12):276-84
pubmed: 24352756
Neurosurg Focus. 2015 Oct;39(4):E7
pubmed: 26424347
J Spinal Disord Tech. 2005 Feb;18(1):14-7
pubmed: 15687846
Spine (Phila Pa 1976). 2012 Jul 15;37(16):1370-4
pubmed: 22261633
Plast Reconstr Surg. 2018 Sep;142(3 Suppl):156S-162S
pubmed: 30138284
Spine J. 2013 Oct;13(10):1393-405
pubmed: 23981819
J Surg Res. 2019 Mar;235:329-339
pubmed: 30691814
World Neurosurg. 2020 Feb;134:e624-e630
pubmed: 31678318
Surgery. 2009 Jul;146(1):40-51
pubmed: 19541009
BMC Surg. 2018 Dec 22;18(1):121
pubmed: 30577832
Eur Spine J. 2018 Oct;27(10):2536-2542
pubmed: 29696391
Spine (Phila Pa 1976). 2009 Aug 1;34(17):1869-72
pubmed: 19644339
Clin Hemorheol Microcirc. 2019;72(4):365-374
pubmed: 30909192
Eur Spine J. 2006 Sep;15(9):1388-96
pubmed: 16835734
Global Spine J. 2017 Dec;7(8):756-761
pubmed: 29238639
Spine (Phila Pa 1976). 2011 Aug 1;36(17):1410-9
pubmed: 21240050
Spine (Phila Pa 1976). 2000 Oct 15;25(20):2663-7
pubmed: 11034653
J Neurosurg Spine. 2014 Jan;20(1):45-52
pubmed: 24206038
Global Spine J. 2018 Dec;8(4 Suppl):5S-30S
pubmed: 30574441
Diabetes Res Clin Pract. 2019 Apr;150:81-89
pubmed: 30825563