Incisional Negative Pressure Wound Therapy in Trauma Laparotomies and Rates of Superficial Surgical Site Infections

Author(s):
Miles Reese; Brendan Roess ; John Hepner; Lee Hogge; Michael Martyak; Ishraq Kabir; Tuan Nguyen; Julia Heaton

Background:

Superficial surgical site infections (SSI) remain a common hospital-acquired condition following surgery and contributes to patient morbidity and mortality. There is limited data on the use of incisional negative pressure wound therapy (iNPWT) in trauma laparotomies, while there is good evidence for the use of iNPWT in the prevention of superficial SSI in other areas. We aim to look at the utility of iNPWT in the care of trauma laparotomy incisions.

Hypothesis:

We hypothesize that iNPWT will decrease the development of superficial SSI and wound dehiscence.

Methods:

A retrospective chart analysis was performed on trauma patients who underwent trauma laparotomies at Sentara Norfolk General Hospital, the level 1 trauma and tertiary referral center for the Hampton Roads area of Virginia. The inclusion criteria included any trauma patient that received an exploratory laparotomy on admission admitted between January 2015 and March 2022 between the ages of 18 and 89. The exclusion criteria included any mortality within 7 days of admission, patients with open abdomens on index procedure or requiring a repeat exploratory laparotomy within 30 days post operatively. Patient demographics, comorbidities, and closure type were documented. A chi-square test of independence was performed to examine the relation between closure type and development of superficial SSI and wound dehiscence. A p-value below 0.05 was deemed statistically significant.

Results:

247 patients were analyzed that met our inclusion and exclusion criteria. 135 patients were closed with iNPWT, 112 patients were closed with staples alone. The proportion of patients who developed superficial SSI was 9.8% for the staples group and 4.4% for the iNPWT group, X2 (1, N = 247) = 2.7, p = .097. The proportion of patients who developed wound dehiscence was 17.8% for the staples group and 6.7% for the iNPWT group, X2 (1, N = 247) = 7.4, p = .006. A subset analysis was done on patients that had a gastric, small bowel, or colonic injury with perforation or injury requiring resection. Within this subset, the proportion of patients who developed superficial SSI was 17.0% for the staples group and 5.3% for the iNPWT group, X2 (1, N = 141) = 5.1, p = .023.

Conclusions:

Our retrospective study showed that there was no statistical difference in the development of superficial SSI between the iNPWT group and staples group, but there was a difference seen in the subgroup which only included gastrointestinal tract perforations or resections. There was a statistical difference in the development of wound dehiscence between the iNPWT group and staples group.