Prophylactic incisional vac in spine surgery

Author(s):
Kyle Mueller; Nirali Patel; Karen Evans; Nathan Nair

Background:

Surgical site infections in spine surgery result in significant patient morbidity as well as increased healthcare cost. Obesity, diabetes, and multiple levels are known to increase a patient’s risk for developing a surgical site infection.

Hypothesis:

We aimed to investigate whether the prophylactic application of closed incisional negative pressure therapy at the time of surgery led to a reduction in the development of infections in high-risk patients.   

Methods:

We prophylactically placed an incisional wound vac on the closed incision at the time of surgery for patients undergoing spine surgery who had at least one of the following indications: suprafascial distance >3cm, obesity, risk factors for wound healing, limited mobility, >3 operative levels or increased tension needed to close the fascial layer (“pull test”). Incisional wound vacs were set at 125 mmHg continuous for 7 days.  Durotomy was a contraindication to placement. Wound complications up to 60 days following surgery were recorded.

Results:

A total of 65 patients underwent ciNPT.  No patient developed a deep surgical site infection requiring a return to the operating room.  1 patient required one week of antibiotics during the outpatient setting for a small non-union at the inferior aspect of a posterior cervical incision secondary to continuous collar wearing.

Conclusions:

Prophylactic ciNPT resulted in no surgical site infections requiring a return to the operating room for debridement in high-risk patients.  This measure can be used to reduce SSI rates and improve the value of spine care.