Negative Pressure Therapy For The Prevention Of Surgical Site Complications In High-Risk Oncologic Patients Aaron Blackham MD, Jason Farrah MD, Thomas McCoy MS, Benjamin Schmidt MD, Perry Shen MD Wake Forest School of Medicine, Winston-Salem, NC Background: Negative pressure therapy (NPT) has been used successfully in a variety of clinical settings to treat infection and promote wound healing. We hypothesize that the use of NPT can prevent SSIs and other incisional complications in high-risk patients undergoing major abdominal oncologic resection. Methods: Between July 2006 and September 2010, 191 oncologic resections were performed for colorectal, pancreatic, and peritoneal surface malignancies. Incisional NPT was used in patients considered to be at increased risk for SSIs. Rates of surgical site complications including SSIs, cellulitis, seroma, hematoma, and dehiscense were determined retrospectively. Results: NPT was used in 104 cases (see Figure); while a standard sterile dressing (SSD) was used in 87. As a group, NPT patients were at higher risk for developing SSIs with a higher incidence of neo-adjuvant chemotherapy (p=0.024), more clean/contaminated cases (p<0.001), longer operative times (p<0.001), more blood loss (p<0.001) and more blood transfusions (p=0.002). Overall, 20.9% of patients developed a SSI and 21.5% required wound opening for any reason. Despite being at increased risk for SSIs, patients who received NPT had fewer surgical site complications than those treated with SSD. NPT was associated with fewer superficial incisional SSIs (6.7 vs 19.5%, p=0.015). In a subgroup analysis of clean- contaminated cases, NPT was associated with fewer superficial incisional SSIs (6.0 vs 27.4%, p=0.001), fewer incisional SSIs (superficial + deep incisional SSI; 11.0 vs 27.4%, p=0.014), fewer total SSIs (16.0 vs 35.5%, p=0.011), and fewer wound openings for any reason (16.0 vs 35.5%, p=0.011). Conclusions: NPT may decrease surgical site complications in high-risk patients undergoing major abdominal surgery. Prospective, randomized studies using NPT for prevention of surgical site complications in general surgery patients are warranted. Figure: Negative Pressure Therapy dressing over closed abdominal incision following a Whipple procedure.
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