Infection rates from surgery, particularly groin incisions, may be lowered by using negative-pressure therapy to manage the surgical incision, resulting in reduced reoperations, readmissions and hospital costs, according to findings presented at the 2017 Society for Vascular Surgery Annual Meeting.
Prior retrospective studies had suggested that application of negative pressure to closed sternal as well as groin incisions decrease wound complications. On this basis, researchers from Thomas Jefferson University in Philadelphia embarked on a prospective, randomized trial to assess the effect of negative-pressure therapy on the outcomes and costs associated with groin incisions made for vascular surgical indications.
“We started the study mainly because complications continue to plague up to 25% of open lower-extremity bypass. It appeared that the main issue was infection. Looking into the literature as to how many others have been addressing it, we noted the potential for negative-pressure therapy,” Paul DiMuzio, MD, FACS, William M. Measey professor of surgery at Thomas Jefferson University, told Cardiology Today’s Intervention.
The negative-pressure therapy (Prevena Incision Management System, Acelity) is primarily used for open-surgery incision, but could be applicable in endovascular procedures if surgical cutdown is required, DiMuzio said.
The randomized, prospective study analyzed 140 femoral incisions categorized as lower or high risk for wound complications. The basis for categorization was BMI > 30 kg/m2, pannus, reoperative surgery, prosthetic graft, poor nutrition, immunosuppression or HbA1c > 8%.
Twenty-one patients were categorized as low risk and were given standard gauze dressing.
Patients considered a high-risk incision were randomly assigned to negative-pressure therapy (n = 59) or standard gauze (n = 60).
For 30 days, researchers evaluated wound complication rate, length of stay, reoperation, readmission and variable hospital costs.
In the two cohorts, there were no significant differences regarding age, sex or risk factors for wound complications.
In the low-risk controls, the major wound complication rate was 4.8%, mean length of stay was 3.8 days, the reoperation and readmission rates were both 4.8% and the average total cost was $17,599.
High-risk controls, however, had a significantly higher rate of major wound complications (21.7%), average length of stay (10.6 days), rate of reoperation (18.3%), rate of readmission (16.7%) and cost ($36,537), the researchers wrote.
Compared with the high-risk control group, the negative-pressure therapy group had lower rates of major wound complications (8.5%; P < .001), reoperations (8.5%; P < .05) and readmissions (6.8%; P < .04), as well as lower costs ($30,429; P = .11), according to the researchers. There was, however, no difference in length of stay (10.6 days).
The device used in the study was associated with a reduced mean total inpatient cost per patient of $6,045.
“If a surgeon identifies a patient who is at high risk for complications, they should consider the Prevena Incision Management System as a method to decrease the incidence of wound complications, such as infection, and ultimately create less burden on the healthcare system in terms of less reoperation, readmission and ultimately less hospital costs,” DiMuzio said in an interview. “We have a nice platform that we can base future studies off of and go from there.” – by Dave Quaile
DiMuzio P, et al. S4: Plenary Session 4. Presented at: Society for Vascular Surgery Vascular Annual Meeting; May 31-June 3, 2017; San Diego.
Disclosure: DiMuzio reports no relevant financial disclosures.