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• W4229797267 abstract "Surgical site infection (SSI) with lower extremity incisions represents a modifiable source of major morbidity. Our institutional bundled care protocol to decrease SSI includes optimization of perioperative risk factors, dedicated wound closure trays, and voluntary use of surface negative pressure wound therapy (NPWT) devices applied over closed incisions in the operating room. This study examined the individual effect of NPWT on SSI reduction and other perioperative outcomes. All patients with lower extremity or infrainguinal incisions between January 2016 and December 2017 were identified from the medical record. All patients were treated with the same perioperative care bundle to reduce SSI. NPWT was applied at the discretion of the surgeon. The 90-day outcomes regarding SSI, return to operating room, death, and readmission were tracked. Univariate and multivariate analysis using binary logistic regression for factors associated with SSI was performed on patients with and without NPWT devices, with P < .05 determined to be significant. There were 504 patients included, 225 in the NPWT group and 279 in the standard therapy group. There were no major differences in baseline demographics between the groups, including mean age, body mass index (mean), perioperative transfusion requirement, use of prosthetic material, reoperative field, dialysis status, and presence of diabetes. There were significantly more women (39.6% vs 27.2%) and active smokers (47.1% vs 30.2%) in the NPWT group (P < .01), along with increased mean operative times (238.3 vs 189.0 minutes; P < .01). Univariate analysis revealed a significantly lower incidence of SSI in the NPWT group, 9.8% vs 19.0% in the non-NPWT group (P < .01), along with decreased perioperative mortality, 5.8% vs 11.2% (P = .04), although there were no differences in return to operating room (27.6% NPWT vs 27.7% standard; P = .97) or readmissions (29.8% NPWT vs 26.5%; P = .43). Binary logistic regression using SSI as the end point variable (Table) demonstrates that female sex increases SSI (odds ratio, 2.43; confidence interval, 1.37-4.30; P < .01), whereas use of NPWT reduces SSI (odds ratio, 0.32; confidence interval, 0.17-0.63; P < .01). The use of NPWT devices decreases the incidence of wound infections. This occurs as an independent factor and as part of patient care bundles targeting modifiable variables in perioperative care.TableLogistic regression analysisP valueOdds ratio95% CIAge, years.091.020.99-1.04Female sex<.012.431.37-4.30Prosthetic graft.590.850.47-1.54Diabetes.821.070.60-1.93Reoperation.141.540.87-2.74Smoker.082.130.91-4.98BMI.951.000.96-1.05Dialysis.480.670.22-2.03Transfusion.141.540.87-2.71Infected field.592.270.97-5.29Length of operation.491.000.99-1.01NPWT use<.010.320.17-0.63Individual surgeon.690.850.39-1.85BMI, Body mass index; CI, confidence interval; NPWT, negative pressure wound therapy. Open table in a new tab" @default.
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• W4229797267 date "2018-08-01" @default.
• W4229797267 modified "2023-09-30" @default.
• W4229797267 title "Negative Pressure Wound Therapy Reduces Surgical Site Infections" @default.
• W4229797267 doi "https://doi.org/10.1016/j.jvs.2018.05.056" @default.
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