Incisional Negative Pressure Wound Therapy Decreases the Frequency of Postoperative Perineal Surgical Site Infections: A Cohort Study
BACKGROUND:Abdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to the hospital system, and delays in further treatment. OBJECTIVE:The aim of this study was to investigate the role of incisional negative pre...
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Published in | Diseases of the colon & rectum Vol. 57; no. 8; pp. 999 - 1006 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
Hagerstown, MDc
The American Society of Colon and Rectal Surgeons
01.08.2014
Lippincott Williams & Wilkins |
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Abstract | BACKGROUND:Abdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to the hospital system, and delays in further treatment.
OBJECTIVE:The aim of this study was to investigate the role of incisional negative pressure wound therapy in decreasing the rates of perineal surgical site infection.
DESIGN:This retrospective cohort study had a historical, consecutively sampled control group.
SETTINGS:This study was conducted at a single-institution tertiary care academic institution.
PATIENTS:All patients undergoing an abdominoperineal resection between 2008 and 2012 were assessed.
INTERVENTIONS:Perineal incisional negative pressure wound therapy was applied to all patients following an abdominoperineal resection between 2010 and 2012 at 125 mmHg continuous suction for 5 days postoperatively.
MAIN OUTCOME MEASURES:The development of a perineal surgical site infection within the first 30 days postoperatively was the primary outcome measured.
RESULTS:Fifty-nine patients were included27 in the incisional negative pressure wound therapy group and 32 in the control group. A statistically lower proportion of perineal surgical site infections were detected in the incisional negative pressure wound therapy group than in the standard dressing group (15% vs 41%; p = 0.02). Both populations were similar in perioperative risk factors, with the exception of increased levels of blood urea nitrogen, a higher proportion of hypertensive patients, and a longer mean operative time in the incisional negative pressure wound therapy group. Additionally, an increased length of stay was observed in the incisional negative pressure wound therapy group (11 vs 8 days; p = 0.03). After adjusting for confounders, including the type of perineal dissection, incisional negative pressure wound therapy was found to be an independent predictor of not developing an surgical site infection (adjusted OR, 0.11; 95% CI, 0.04-0.66; p = 0.01).
LIMITATIONS:The study’s retrospective nature limits the results because of the risk of interpreter bias, although this was addressed in part by reviewing data in duplicate. We controlled for the potential for selection bias with our consecutive sampling model.
CONCLUSIONS:Our study demonstrates a role for incisional negative pressure wound therapy in decreasing rates of perineal surgical site infection following abdominoperineal resection. Prospective randomized trials will be required to further investigate this intervention. |
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AbstractList | BACKGROUND:Abdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to the hospital system, and delays in further treatment.
OBJECTIVE:The aim of this study was to investigate the role of incisional negative pressure wound therapy in decreasing the rates of perineal surgical site infection.
DESIGN:This retrospective cohort study had a historical, consecutively sampled control group.
SETTINGS:This study was conducted at a single-institution tertiary care academic institution.
PATIENTS:All patients undergoing an abdominoperineal resection between 2008 and 2012 were assessed.
INTERVENTIONS:Perineal incisional negative pressure wound therapy was applied to all patients following an abdominoperineal resection between 2010 and 2012 at 125 mmHg continuous suction for 5 days postoperatively.
MAIN OUTCOME MEASURES:The development of a perineal surgical site infection within the first 30 days postoperatively was the primary outcome measured.
RESULTS:Fifty-nine patients were included27 in the incisional negative pressure wound therapy group and 32 in the control group. A statistically lower proportion of perineal surgical site infections were detected in the incisional negative pressure wound therapy group than in the standard dressing group (15% vs 41%; p = 0.02). Both populations were similar in perioperative risk factors, with the exception of increased levels of blood urea nitrogen, a higher proportion of hypertensive patients, and a longer mean operative time in the incisional negative pressure wound therapy group. Additionally, an increased length of stay was observed in the incisional negative pressure wound therapy group (11 vs 8 days; p = 0.03). After adjusting for confounders, including the type of perineal dissection, incisional negative pressure wound therapy was found to be an independent predictor of not developing an surgical site infection (adjusted OR, 0.11; 95% CI, 0.04-0.66; p = 0.01).
LIMITATIONS:The study’s retrospective nature limits the results because of the risk of interpreter bias, although this was addressed in part by reviewing data in duplicate. We controlled for the potential for selection bias with our consecutive sampling model.
CONCLUSIONS:Our study demonstrates a role for incisional negative pressure wound therapy in decreasing rates of perineal surgical site infection following abdominoperineal resection. Prospective randomized trials will be required to further investigate this intervention. BACKGROUNDAbdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to the hospital system, and delays in further treatment.OBJECTIVEThe aim of this study was to investigate the role of incisional negative pressure wound therapy in decreasing the rates of perineal surgical site infection.DESIGNThis retrospective cohort study had a historical, consecutively sampled control group.SETTINGSThis study was conducted at a single-institution tertiary care academic institution.PATIENTSAll patients undergoing an abdominoperineal resection between 2008 and 2012 were assessed.INTERVENTIONSPerineal incisional negative pressure wound therapy was applied to all patients following an abdominoperineal resection between 2010 and 2012 at 125 mmHg continuous suction for 5 days postoperatively.MAIN OUTCOME MEASURESThe development of a perineal surgical site infection within the first 30 days postoperatively was the primary outcome measured.RESULTSFifty-nine patients were included: 27 in the incisional negative pressure wound therapy group and 32 in the control group. A statistically lower proportion of perineal surgical site infections were detected in the incisional negative pressure wound therapy group than in the standard dressing group (15% vs 41%; p = 0.02). Both populations were similar in perioperative risk factors, with the exception of increased levels of blood urea nitrogen, a higher proportion of hypertensive patients, and a longer mean operative time in the incisional negative pressure wound therapy group. Additionally, an increased length of stay was observed in the incisional negative pressure wound therapy group (11 vs 8 days; p = 0.03). After adjusting for confounders, including the type of perineal dissection, incisional negative pressure wound therapy was found to be an independent predictor of not developing an surgical site infection (adjusted OR, 0.11; 95% CI, 0.04-0.66; p = 0.01).LIMITATIONSThe study's retrospective nature limits the results because of the risk of interpreter bias, although this was addressed in part by reviewing data in duplicate. We controlled for the potential for selection bias with our consecutive sampling model.CONCLUSIONSOur study demonstrates a role for incisional negative pressure wound therapy in decreasing rates of perineal surgical site infection following abdominoperineal resection. Prospective randomized trials will be required to further investigate this intervention. Abdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to the hospital system, and delays in further treatment. The aim of this study was to investigate the role of incisional negative pressure wound therapy in decreasing the rates of perineal surgical site infection. This retrospective cohort study had a historical, consecutively sampled control group. This study was conducted at a single-institution tertiary care academic institution. All patients undergoing an abdominoperineal resection between 2008 and 2012 were assessed. Perineal incisional negative pressure wound therapy was applied to all patients following an abdominoperineal resection between 2010 and 2012 at 125 mmHg continuous suction for 5 days postoperatively. The development of a perineal surgical site infection within the first 30 days postoperatively was the primary outcome measured. Fifty-nine patients were included: 27 in the incisional negative pressure wound therapy group and 32 in the control group. A statistically lower proportion of perineal surgical site infections were detected in the incisional negative pressure wound therapy group than in the standard dressing group (15% vs 41%; p = 0.02). Both populations were similar in perioperative risk factors, with the exception of increased levels of blood urea nitrogen, a higher proportion of hypertensive patients, and a longer mean operative time in the incisional negative pressure wound therapy group. Additionally, an increased length of stay was observed in the incisional negative pressure wound therapy group (11 vs 8 days; p = 0.03). After adjusting for confounders, including the type of perineal dissection, incisional negative pressure wound therapy was found to be an independent predictor of not developing an surgical site infection (adjusted OR, 0.11; 95% CI, 0.04-0.66; p = 0.01). The study's retrospective nature limits the results because of the risk of interpreter bias, although this was addressed in part by reviewing data in duplicate. We controlled for the potential for selection bias with our consecutive sampling model. Our study demonstrates a role for incisional negative pressure wound therapy in decreasing rates of perineal surgical site infection following abdominoperineal resection. Prospective randomized trials will be required to further investigate this intervention. |
Author | Brackstone, Muriel Britto, Karen Ott, Michael C Kidane, Biniam Chadi, Sami A |
AuthorAffiliation | 1Division of General Surgery, London Health Sciences Centre, London, Ontario, Canada 2Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada |
AuthorAffiliation_xml | – name: 1Division of General Surgery, London Health Sciences Centre, London, Ontario, Canada 2Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada |
Author_xml | – sequence: 1 givenname: Sami surname: Chadi middlename: A fullname: Chadi, Sami A organization: 1Division of General Surgery, London Health Sciences Centre, London, Ontario, Canada 2Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada – sequence: 2 givenname: Biniam surname: Kidane fullname: Kidane, Biniam – sequence: 3 givenname: Karen surname: Britto fullname: Britto, Karen – sequence: 4 givenname: Muriel surname: Brackstone fullname: Brackstone, Muriel – sequence: 5 givenname: Michael surname: Ott middlename: C fullname: Ott, Michael C |
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Cites_doi | 10.1016/j.amjsurg.2012.10.004 10.1097/01.sla.0000219017.78611.49 10.1097/DCR.0b013e3182a39959 10.1055/s-2008-1055325 10.1007/DCR.0b013e3181b71ef9 10.1007/BF02052590 10.1016/j.amjsurg.2012.06.007 10.1097/01.bot.0000211159.98239.d2 10.1007/BF02234816 10.1007/s10350-004-0855-x 10.1016/S1470-2045(03)01191-4 10.1086/505220 10.1002/bjs.1800790108 10.1016/S0196-6553(05)80201-9 10.1007/BF02052594 10.1089/sur.2012.059 10.1016/j.jamcollsurg.2011.04.004 10.1016/S0140-6736(00)99076-7 10.1111/j.1463-1318.2005.00911.x 10.1111/j.1463-1318.2006.01159.x |
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Keywords | Postoperative Nosocomial infection Wound closure Negative pressure Abdominoperineal resection Wound Treatment Surgery Cohort study Gastroenterology Rectum Colon Colon and rectal surgery Incisional negative pressure wound therapy |
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Snippet | BACKGROUND:Abdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to... Abdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to the... BACKGROUNDAbdominoperineal resection is a procedure associated with high rates of perineal surgical site infections, causing distress to the patient, costs to... |
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SubjectTerms | Anus Neoplasms - pathology Anus Neoplasms - surgery Anus Neoplasms - therapy Biological and medical sciences Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - surgery Carcinoma, Squamous Cell - therapy Case-Control Studies Female Gastroenterology. Liver. Pancreas. Abdomen General aspects Human infectious diseases. Experimental studies and models Humans Infectious diseases Male Medical sciences Middle Aged Negative-Pressure Wound Therapy - methods Neoadjuvant Therapy Neoplasm Staging Perineum Rectal Neoplasms - pathology Rectal Neoplasms - surgery Rectal Neoplasms - therapy Retrospective Studies Risk Factors Surgical Wound Infection - prevention & control |
Title | Incisional Negative Pressure Wound Therapy Decreases the Frequency of Postoperative Perineal Surgical Site Infections: A Cohort Study |
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