Effect of negative pressure wound therapy in exploratory laparotomies with coexisting ostomy

The Southwest Respiratory and Critical Care Chronicles Pub Date : 2022-07-22 DOI:10.12746/swrccc.v10i44.1061

Avery Williams, K. Shrestha, Alexis Cruz, Anastazia Gilman, Jonathan Huynh, Justin G. Vaughan, Ariel P. Santos

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Abstract

Background: Surgical site infection (SSI) is one of the most common healthcare-associated infections. The use of negative pressure wound therapy (NPWT) has shown to decrease the overall rate of SSI, wound dehiscence, and length of hospital stay in surgical conditions. This study aims to determine the impact of NPWT applied on closed surgical incisions on patients with coexisting ostomy undergoing exploratory laparotomy. Methods: A retrospective study on patients who underwent exploratory laparotomies from 2017 to 2019 was conducted. NPWT was compared to standard post-operative surgical wound dressing. A sub-analysis of patients with ostomies was performed. Results: A total of 286 patients who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received standard dressing. The NPWT group had a higher percentage of patients with an ostomy (37.3% vs 20.4%, P=.016), of which 25.5% were colostomies (vs 12.3%) and 11.8% were ileostomies (vs 8.1%) with P=.002. No significant difference in the overall rate of SSI (7.8% vs 5.5%, P= .517), wound dehiscence (7.8% vs 2.1 %, P=.057), and seroma formation (3.9% vs 2.1%, P=.612) were observed. The mean length of ICU stay (3.5 vs 7.0, P=.051) and unplanned reoperation (5.9% vs 16.6%, P=.051) were lower in the NPWT group compared to the control group. Sub analysis of patients with stoma found no significant difference in SSI. Conclusions: In our study, the use of NPWT on closed surgical incision wound was not associated with the reduction of SSI in patients with ostomies. Large studies are needed to ascertain significant benefits in patients with ostomies. Keywords: negative pressure wound therapy, surgical site infection, ostomy, exploratory laparotomy

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负压伤口治疗在剖腹探查术并发造口术中的效果

背景:手术部位感染(SSI)是最常见的卫生保健相关感染之一。负压伤口治疗(NPWT)的使用已被证明可以降低手术条件下SSI的总体发生率、伤口裂开和住院时间。本研究旨在确定NPWT应用于闭合性手术切口对合并造口患者行剖腹探查术的影响。方法:对2017 - 2019年剖腹探查术患者进行回顾性研究。将NPWT与标准术后外科创面敷料进行比较。对造口患者进行亚组分析。结果:共发现286例剖腹探查患者;51例患者接受NPWT, 235例患者接受标准敷料。NPWT组造口比例较高(37.3% vs 20.4%， P= 0.016)，其中结肠造口比例为25.5% (vs 12.3%)，回肠造口比例为11.8% (vs 8.1%)， P= 0.002。两组SSI发生率(7.8% vs 5.5%， P= 0.517)、创面裂开(7.8% vs 2.1%， P= 0.057)、血肿形成(3.9% vs 2.1%， P= 0.612)差异无统计学意义。NPWT组患者的平均ICU住院时间(3.5 vs 7.0, P= 0.051)和非计划再手术(5.9% vs 16.6%， P= 0.051)均低于对照组。对有造口的患者进行亚组分析，发现SSI无显著差异。结论:在我们的研究中，NPWT在闭合性手术切口伤口上的使用与造口患者SSI的减少无关。需要大量的研究来确定造口术对患者的显著益处。关键词:负压伤口治疗，手术部位感染，造口术，剖腹探查

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The Southwest Respiratory and Critical Care Chronicles

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