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Oe S, Swamy G, Gagliardi M, Lewis SJ, Kato S, Shaffrey CI, Lenke LG, Matsuyama Y. Wound Closure and Wound Dressings in Adult Spinal Deformity Surgery From the AO Spine Surveillance of Post-Operative Management. Global Spine J 2024:21925682241262749. [PMID: 38869180 DOI: 10.1177/21925682241262749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
STUDY DESIGN An e-mail-based online survey for adult spinal deformity (ASD) surgeons. OBJECTIVE Wound closure and dressing techniques may vary according to the discretion of the surgeon as well as geographical location. However, there are no reports on most common methods. The purpose of this study is to clarify the consensus. METHODS An online survey was distributed via email to AO Spine members. Responses from 164 ASD surgeons were surveyed. The regions were divided into 5 regions: Europe and South Africa (ESA), North America (NA), Asia Pacific (AP), Latin America (LA), and Middle East and North Africa (MENA). Wound closure methods were evaluated by glue(G), staples(S), external non-absorbable sutures (ENS), tapes(T), and only subcuticular absorbable suture (SAS). Wound Dressings consisted of dry dressing (D), plastic occlusive dressing (PO), G, Dermabond Prineo (DP). RESULTS The number of respondents were 57 in ESA, 33 in NA, 36 in AP, 22 in LA, and 16 in MENA. S (36.4%) was the most used wound closure method. This was followed by ENS (26.2%), SAS (14.4%), G (11.8%), and T (11.3%). S use was highest in ESA (44.3%), NA (28.6%), AP (31.7%), and MENA (58.8%). D was used by 50% of surgeons postoperatively. AP were most likely to use PO (36%). 21% of NA used DP, while between 0%-9% of surgeons used it in the rest of the world. CONCLUSION Wound closure and dressings methods differ in the region. There are no current guidelines with these choices. Future studies should seek to standardize these choices.
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Affiliation(s)
- Shin Oe
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Ganesh Swamy
- Department of Surgery, Cumming School of Medicine, Calgary, AB, Canada
| | - Martin Gagliardi
- Department of Surgery, Cumming School of Medicine, Calgary, AB, Canada
| | - Stephen J Lewis
- Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University of Toronto, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Lawrence G Lenke
- Department of Orthopedic Spine Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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Ambrosio L, Vadalà G, Tavakoli J, Scaramuzzo L, Brodano GB, Lewis SJ, Kato S, Cho SK, Yoon ST, Kim HJ, Gary MF, Denaro V. Surgeon Preference Regarding Wound Dressing Management in Lumbar Fusion Surgery: An AO Spine Global Cross-Sectional Study. Neurospine 2024; 21:204-211. [PMID: 38569644 PMCID: PMC10992664 DOI: 10.14245/ns.2347168.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE To evaluate the global practice pattern of wound dressing use after lumbar fusion for degenerative conditions. METHODS A survey issued by AO Spine Knowledge Forums Deformity and Degenerative was sent out to AO Spine members. The type of postoperative dressing employed, timing of initial dressing removal, and type of subsequent dressing applied were investigated. Differences in the type of surgery and regional distribution of surgeons' preferences were analyzed. RESULTS Right following surgery, 60.6% utilized a dry dressing, 23.2% a plastic occlusive dressing, 5.7% glue, 6% a combination of glue and polyester mesh, 2.6% a wound vacuum, and 1.2% other dressings. The initial dressing was removed on postoperative day 1 (11.6%), 2 (39.2%), 3 (20.3%), 4 (1.7%), 5 (4.3%), 6 (0.4%), 7 or later (12.5%), or depending on drain removal (9.9%). Following initial dressing removal, 75.9% applied a dry dressing, 17.7% a plastic occlusive dressing, and 1.3% glue, while 12.1% used no dressing. The use of no additional coverage after initial dressing removal was significantly associated with a later dressing change (p < 0.001). Significant differences emerged after comparing dressing management among different AO Spine regions (p < 0.001). CONCLUSION Most spine surgeons utilized a dry or plastic occlusive dressing initially applied after surgery. The first dressing was more frequently changed during the first 3 postoperative days and replaced with the same type of dressing. While dressing policies tended not to vary according to the type of surgery, regional differences suggest that actual practice may be based on personal experience rather than available evidence.
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Affiliation(s)
- Luca Ambrosio
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Gianluca Vadalà
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Javad Tavakoli
- School of Biomedical Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, Australia
| | - Laura Scaramuzzo
- Spine Surgery Division 1, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | | | - Stephen J Lewis
- UHN-Orthopedics, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - S Tim Yoon
- Department of Orthopaedics, Emory University, Atlanta, GA, USA
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Matthew F Gary
- Departments of Neurosurgery and Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Vincenzo Denaro
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Li J, Jiang D, Chang Z. Investigating the efficacy of vacuum sealing drainage versus traditional negative pressure drainage in treating deep incision infections following posterior cervical internal fixation-a retrospective cohort study. Eur J Med Res 2024; 29:125. [PMID: 38360845 PMCID: PMC10868024 DOI: 10.1186/s40001-024-01717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Assessing the efficacy and safety of Vacuum Sealing Drainage (VSD) in treating deep incision infections (DII) following posterior cervical internal fixation. METHODS We retrospectively studied the clinical effects of VSD and Traditional Negative Pressure Drainage (TND) on 12 patients with deep incision infection after posterior cervical fixation surgery who were treated in our department from 2012 to 2020. A comparison of patient-related factors (age, gender, BMI, comorbidities, initial internal fixation surgery segment, preoperative laboratory inflammation indicators) and surgical-related factors (postoperative duration of fever, positive rate of drainage fluid bacterial culture, Visual Analogue Scale (VAS) score at 3 days after surgery, laboratory indicators at 3 days after surgery, debridement frequency and drainage time, hospital stay, internal fixation retention rate, and infection recurrence rate) between the VSD group and the TND group was conducted using independent sample t tests to draw experimental conclusions. RESULTS This study included 12 patients, with six cases of VSD (5 males and 1 female) and six cases of TND (4 males and 2 females). The VSD group had significantly lower postoperative fever time (1.50 ± 0.46 days vs. 4.28 ± 0.97 days, P < 0.05), a higher positive rate of bacterial cultures in drainage fluid (5/6 vs. 2/6, P < 0.05), lower 3 day VAS scores (3.13 ± 0.83 vs. 3.44 ± 0.88, P < 0.05), lower 3 day CRP levels (66.89 ± 23.65 mg/L vs. 57.11 ± 18.18 mg/L, P < 0.05), a shorter total drainage time (14.50 ± 2.98 days vs. 22.56 ± 3.01 days, P < 0.05), and a higher total drainage flow rate (395.63 ± 60.97 ml vs. 155.56 ± 32.54 ml, P < 0.05) than the TND group (the total drainage volume throughout the entire treatment process). In addition, the frequency of debridement (2.67 ± 0.52 times vs. 3.17 ± 0.41 times, P < 0.05) and average hospital stay (23.13 ± 3.27 days vs. 34.33 ± 6.86 days, P < 0.05) were significantly lower in the VSD group, although both groups retained internal fixation. CONCLUSIONS VSD is a secure and effective treatment for deep incision infections that results from cervical posterior internal fixation surgery.
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Affiliation(s)
- Jianhua Li
- Department of Orthopaedic Surgery, 960th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China
| | - Dawei Jiang
- Department of Orthopaedic Surgery, 960th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China
| | - Zhengqi Chang
- Department of Orthopaedic Surgery, 960th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China.
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Yang H, Bao L, Li J, Wang Y, Yang J. Effect of wound drainage on the wound infection and healing in patients undergoing spinal surgery: A meta-analysis. Int Wound J 2024; 21:e14778. [PMID: 38356179 PMCID: PMC10867381 DOI: 10.1111/iwj.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 02/16/2024] Open
Abstract
A meta-analysis was conducted to comprehensively evaluate the impact of wound drainage on postoperative wound infection and healing in patients undergoing spinal surgery. Computer searches were performed, from database inception to October 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for studies related to the application of wound drainage in spinal surgery. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 11 articles involving 2102 spinal surgery patients were included. The analysis showed that, compared to other treatment methods, the use of wound drainage in spinal surgery patients significantly shortened the wound healing time (standardized mean difference [SMD]: -1.35, 95% confidence intervals [CI]: -1.91 to -0.79, p < 0.001). However, there was no statistical difference in the incidence of wound infection (odds ratio: 1.35, 95% CI: 0.83-2.19, p = 0.226). This study indicates that wound drainage in patients undergoing spinal surgery is effective, can accelerate wound healing and is worth promoting in clinical practice.
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Affiliation(s)
- Huiming Yang
- Department of Orthopedic SurgeryChinese Medicine Hospital of Tiantai CountyTaizhouChina
| | - Lizhen Bao
- Department of Orthopedic SurgeryChinese Medicine Hospital of Tiantai CountyTaizhouChina
| | - Jianchun Li
- Department of Orthopedic SurgeryChinese Medicine Hospital of Tiantai CountyTaizhouChina
| | - Yipeng Wang
- Department of Orthopedic SurgeryTaizhou Municipal HospitalTaizhouChina
| | - Jun Yang
- Department of Orthopedic SurgeryThe People's Hospital of Tiantai CountyTaizhouChina
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Lu S, Yuan Z, He X, Du Z, Wang Y. The impact of negative pressure wound therapy on surgical wound infection, hospital stay and postoperative complications after spinal surgery: A meta-analysis. Int Wound J 2024; 21:e14378. [PMID: 37697710 PMCID: PMC10784618 DOI: 10.1111/iwj.14378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
To systematically assess the effect of negative pressure wound therapy (NPWT) on postoperative surgical wound infection, length of hospital stay and postoperative complications after spinal surgery. Relevant studies on the application of NPWT in spinal surgery were conducted via a computerised database search, including PubMed, EMBASE, Web of Science, MEDLINE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang, from inception to June 2023. The identified literature was rigorously screened and data extraction was performed by two investigators independently. The quality of the relevant studies was evaluated using the Newcastle-Ottawa scale (NOS). The effect size for count data was determined by the odds ratio (OR), while the impact size for measurement data was expressed as the standardised mean difference (SMD). The 95% confidence interval (CI) was calculated for each effect magnitude. Stata 17.0 software was used for the meta-analysis. Ten papers, totalling 1448 patients, were finally included. This study demonstrated that NPWT led to a statistically significant reduction in the occurrence of postoperative surgical wound infections (OR: 0.377, 95% CI: 0.238-0.598, p < 0.001), fewer postoperative complications (OR: 0.526, 95% CI: 0.360-0.770, p = 0.001) and a shortened hospital stay (SMD: -0.678, 95%CI: -1.324 to -0.031, p = 0.040) after spinal surgery compared with the control group. When compared with other treatment approaches, NPWT also demonstrated a substantial reduction in surgical wound infections and postoperative complications, as well as a shorter duration of hospitalisation after spinal surgery.
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Affiliation(s)
- Shengwei Lu
- Department of SpineThe Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou CityZhuzhouChina
| | - Zan Yuan
- Department of SpineThe Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou CityZhuzhouChina
| | - Xinning He
- Department of SpineThe Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou CityZhuzhouChina
| | - Zhiyong Du
- Department of SpineThe Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou CityZhuzhouChina
| | - Ying Wang
- Department of SpineThe Orthopedics Hospital of Traditional Chinese Medicine Zhuzhou CityZhuzhouChina
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Liu Z, Tian S. Influence of closed-incision negative-pressure wound therapy on the incidence of surgical site wound infection in patients undergoing spine surgery: A meta-analysis. Int Wound J 2023; 20:4193-4199. [PMID: 37518769 PMCID: PMC10681537 DOI: 10.1111/iwj.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
The present meta-analysis was conducted to comprehensively assess the impact of closed-incision negative-pressure wound therapy (ciNPWT) on the incidence of surgical site infections (SSIs) in patients undergoing spinal fusion surgery, thereby aiming to provide evidence-based support for the prevention of postoperative wound infections during spinal surgery. Relevant studies pertaining to the application of ciNPWT in spinal surgery were retrieved through searches of the PubMed, Embase, MEDLINE and Cochrane Library databases, spanning from their inception to May 2023. The literature screening and data extraction were performed by two researchers based on predefined inclusion and exclusion criteria, followed by a quality assessment of the included studies. Meta-analyses were performed using the odds ratios (ORs) and standardised mean differences (SMDs) as effect variables. RevMan 14.0 and STATA 17.0 were employed for meta-analysis of the extracted data. In total, eight articles involving 1198 patients, including 391 in the experimental group and 807 in the control group, were included. The meta-analysis results revealed that ciNPWT significantly reduced the incidence of SSIs in patients undergoing spinal fusion surgery (OR, 0.39; 95% CI: 0.22-0.67, p = 0.0007); however, it did not lead to a reduction in hospital stay duration (SMD: -0.48, 95% CI: -0.98 to 0.01, p = 0.06). Existing evidence suggests that ciNPWT has a positive impact on patients undergoing spinal fusion surgery, as it significantly reduces the incidence of postoperative surgical site wound infections; however, it does not result in a shorter hospital stay for patients.
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Affiliation(s)
- Zhi‐Shen Liu
- Department of OrthopedicsJincheng General HospitalJinchengChina
| | - Shao‐Bin Tian
- Department of OrthopedicsJincheng General HospitalJinchengChina
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7
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Tang Y, Liu L, Jie R, Tang Y, Zhao X, Xu M, Chen M. Negative pressure wound therapy promotes wound healing of diabetic foot ulcers by up-regulating PRDX2 in wound margin tissue. Sci Rep 2023; 13:16192. [PMID: 37758743 PMCID: PMC10533814 DOI: 10.1038/s41598-023-42634-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
To understand the changes in the peroxiredoxin-2 (PRDX2) expression level in the wound margin tissue (T-PRDX2) of patients with diabetic foot ulcer (DFU) before and after negative pressure wound therapy (NPWT). Additionally, the study aimed to explore the association between PRDX2 expression and the treatment outcome of DFUs to provide a new theoretical basis for revealing the mechanism of NPWT promoting the healing of DFUs. Fifty-six type 2 diabetes patients with foot ulcers undergoing NPWT (the DFU group) and 28 patients with chronic lower limb skin ulcers with normal glucose tolerance undergoing NPWT (the skin ulcer control [SUC] group) were included in the study. T-PRDX2 was detected using Western blotting, and the superoxide dismutase (SOD) activity and the malondialdehyde (MDA) and glutathione (GSH) levels were detected using a biochemical method. In addition, in vitro experiments were conducted to determine the effect of PRDX2 expression on normal human dermal fibroblast (NHDF) proliferation, migration, and apoptosis. Before NPWT, the DFU group exhibited a significantly lower T-PRDX2 expression level compared with the SUC group. After one week of NPWT, the T-PRDX2 expression level, SOD activity, and GSH content in the wound margin tissues of the DFU and SUC groups significantly increased compared with the before NPWT levels. Conversely, the inflammatory indicators (white blood cell, neutrophil percentage, C-reactive protein, and procalcitonin) and MDA content were significantly lower than the before NPWT levels. The expression changes of T-PRDX2 before and after NPWT in the DFU and SUC groups were positively correlated with the 4-week wound healing rate. In vitro experiments demonstrated that PRDX2 could alleviate the oxidative stress in NHDFs, thereby promoting their proliferation and migration, while reducing cell apoptosis. NPWT promotes DFU healing by increasing T-PRDX2, and changes in the T-PRDX2 might be associated with the therapeutic effect of NPWT.
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Affiliation(s)
- Ying Tang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City, Anhui Province, People's Republic of China
| | - Lei Liu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City, Anhui Province, People's Republic of China
| | - Ruyan Jie
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City, Anhui Province, People's Republic of China
| | - Yizhong Tang
- Department of Burns, The First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, People's Republic of China
| | - Xiaotong Zhao
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City, Anhui Province, People's Republic of China
| | - Murong Xu
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City, Anhui Province, People's Republic of China.
| | - Mingwei Chen
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 Jixi Road, Shushan District, Hefei City, Anhui Province, People's Republic of China.
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Wells ME, Powlan FJ, Kieb SC, Parnes N, Cleveland AW. Combined Incisional Negative Pressure Wound Therapy and Subfascial Suction Drainage: The Suction Taco Approach. Cureus 2023; 15:e43577. [PMID: 37719597 PMCID: PMC10503535 DOI: 10.7759/cureus.43577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
An 18-year-old male with T4-L3 adult idiopathic scoliosis was treated with posterior spinal fusion followed by the application of a combined incisional negative pressure wound therapy (NPWT) and subfascial suction drainage system. In this report, we describe a novel technique that incorporates subfascial drains into an NPWT incisional vacuum system leading to a single exiting suction line. This effectively mitigates drain burden, maintains a sterile environment during the in-hospital postoperative period, provides NPWT to the drain exiting and incisional sites, and provides negative pressure-assisted deep space closure.
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Affiliation(s)
- Matthew E Wells
- Orthopaedics and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Franklin J Powlan
- Orthopaedics and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Steven C Kieb
- Orthopaedic Surgery and Rehabilitation, Carthage Area Hospital, Carthage, USA
| | - Nata Parnes
- Orthopaedic Surgery, Claxton-Hepburn Medical Center, Ogdensburg, USA
- Orthopaedic Surgery and Rehabilitation, Carthage Area Hospital, Carthage, USA
| | - Andrew W Cleveland
- Orthopaedics and Rehabilitation, William Beaumont Army Medical Center, El Paso, USA
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Mehkri Y, Sharaf R, Tishad A, Gendreau J, Hernandez J, Panther E, Pafford R, Rahmathulla G. Cost Savings Associated with Vacuum-Assisted Closure in Trauma Patients Undergoing Posterior Spinal Fusion. World Neurosurg 2023; 171:e147-e152. [PMID: 36442776 DOI: 10.1016/j.wneu.2022.11.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the implications of vacuum-assisted closure (VAC) versus standard wound dressings on postoperative posterior spinal fusion (PSF) wounds with respect to potential cost savings associated with reduced incidence of surgical site infections. METHODS This was a retrospective review of trauma patients who underwent open PSF under the care of a single surgeon at a Level I trauma center. Patients were postoperatively monitored for 90 days. Statistical analysis was performed with χ2 testing with the calculation of number needed to treat values. RESULTS Inclusion criteria were met by 208 patients who underwent open PSF. The χ2 test revealed a significant increase in incidence of surgical site infections (20% vs. 8%; P = 0.021) in the non-VAC group (n = 112) compared with the VAC group (n = 96). Cost-benefit analysis revealed that use of VAC in patients undergoing open PSF could enable a mean cost savings of $163,492 per 100 patients. CONCLUSIONS Use of VAC in patients undergoing open PSF was associated with a 2-fold decrease in incidence of surgical site infections and an infection-related cost savings of $163,492 per 100 patients. Further investigation is needed to ascertain additional benefits of VAC usage in patients undergoing open PSF.
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Affiliation(s)
- Yusuf Mehkri
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ramy Sharaf
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Abtahi Tishad
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Jairo Hernandez
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Eric Panther
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ryan Pafford
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gazanfar Rahmathulla
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA; Department of Neurosurgery, Mayo Clinic Health System, Eau Claire, Wisconsin, USA.
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Cooper HJ, Singh DP, Gabriel A, Mantyh C, Silverman R, Griffin L. Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4722. [PMID: 36936465 PMCID: PMC10019176 DOI: 10.1097/gox.0000000000004722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/26/2022] [Indexed: 03/18/2023]
Abstract
Closed incision negative pressure therapy (ciNPT) has been utilized to help manage closed incisions across many surgical specialties. This systematic review and meta-analysis evaluated the effect of ciNPT on postsurgical and health economic outcomes. Methods A systematic literature search using PubMed, EMBASE, and QUOSA was performed for publications written in English, comparing ciNPT to standard-of-care dressings between January 2005 and August 2021. Study participant characteristics, surgical procedure, dressings used, treatment duration, postsurgical outcomes, and follow-up data were extracted. Meta-analyses were performed using random-effects models. Risk ratios summarized dichotomous outcomes. Difference in means or standardized difference in means was used to assess continuous variables reported on the same scale or outcomes reported on different scales/measurement instruments. Results The literature search identified 84 studies for analysis. Significant reductions in surgical site complication (SSC), surgical site infection (SSI), superficial SSI, deep SSI, seroma, dehiscence, skin necrosis, and prolonged incisional drainage were associated with ciNPT use (P < 0.05). Reduced readmissions and reoperations were significant in favor of ciNPT (P < 0.05). Patients receiving ciNPT had a 0.9-day shorter hospital stay (P < 0.0001). Differences in postoperative pain scores and reported amounts of opioid usage were significant in favor of ciNPT use (P < 0.05). Scar evaluations demonstrated improved scarring in favor of ciNPT (P < 0.05). Discussion For these meta-analyses, ciNPT use was associated with statistically significant reduction in SSCs, SSIs, seroma, dehiscence, and skin necrosis incidence. Reduced readmissions, reoperation, length of hospital stay, decreased pain scores and opioid use, and improved scarring were also observed in ciNPT patients.
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Affiliation(s)
- H. John Cooper
- From the Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, N.Y
| | - Devinder P. Singh
- Department of Plastic Surgery, University of Miami Health System and Miller School of Medicine, Miami, Fla
| | | | | | - Ronald Silverman
- Department of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
- Medical Solutions Division, 3M, St Paul, Minn
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Mehkri Y, Hernandez J, Panther E, Gendreau J, Pafford R, Rao D, Fiester P, Rahmathulla G. Incisional Wound Vacuum-Evaluation of Wound Outcomes in Comparison With Standard Dressings for Posterior Spinal Fusions in Traumatic Patients. Oper Neurosurg (Hagerstown) 2023; 24:138-144. [PMID: 36637298 DOI: 10.1227/ons.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Postoperative incisional negative pressure wound vacuum-assisted closure (VAC) dressings are being used as a primary dressing to optimize wound healing and help avoid complications of infection and dehiscence. Few studies have investigated whether application of VAC dressings on postoperative posterior spinal wounds can reduce the incidence of surgical site infections. OBJECTIVE To describe our single-surgeon experience of using primary VAC after posterior spinal fusion (PSF) in a large sample of trauma patients. METHODS This was an Institutional Review Board-approved retrospective comparative study and included all trauma patients presenting to our level 1 safety-net trauma center who required PSF and were operated on by the senior surgeon between 2016 and 2021. Primary outcomes were complications (surgical site infection, readmission for infection, and wound-related return to operating room [OR]) within 90 days after surgery. χ2 testing and Student t testing were used to assess differences between treatment groups while bivariate and multivariate regression was performed for outcome assessment. RESULTS Two hundred sixty-four patients met criteria and were included. One hundred fifty-seven (59%) were treated with standard dressing and 107 (41%) with VAC. Patients treated with VAC were more likely to be older (P = .015), have diabetes (P = .041), have an elevated body mass index (P = .020), and had more levels of fusion (P = .002). Despite this, presence of VAC was independently associated with decreased 90-day infection (hazard ratio = 0.397, P = .023) and decreased 90-day return to OR for wound-related reasons (hazard ratio = 0.099, P = .031). CONCLUSION Compared with the use of standard dressing, VAC was found to decrease surgical site infection and return to OR risk in trauma patients undergoing PSF.
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Affiliation(s)
- Yusuf Mehkri
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Jairo Hernandez
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Eric Panther
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, USA
| | - Ryan Pafford
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Dinesh Rao
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Peter Fiester
- Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Gazanfar Rahmathulla
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
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Wang J, Yang Y, Xing W, Xing H, Bai Y, Chang Z. Safety and efficacy of negative pressure wound therapy in treating deep surgical site infection after lumbar surgery. INTERNATIONAL ORTHOPAEDICS 2022; 46:2629-2635. [PMID: 35931831 DOI: 10.1007/s00264-022-05531-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of negative pressure wound therapy (NPWT) for post-operative deep surgical site infection (SSI) after posterior instrumented spinal surgery. METHODS We retrospectively compared the clinical outcomes of NPWT with standard debridement for deep SSI after posterior instrumented spinal surgery from 2012 to 2020 in our department. The primary outcomes were peri-operative characteristics including positive organism results, duration of fever, and visual analogue scale (VAS) pain scores three days after re-operation. The secondary outcomes were post-operative characteristics including implant infection recurrence, implant retention rate, duration of hospitalization, and VAS at discharge. Pearson's chi-squared analysis (categorical) and Student's t test (continuous) were used to determine the differences. RESULTS Thirty-four patients were included, of which 19 underwent NPWT, and 15 underwent standard debridement. Patients in the NPWT group all significantly improved primary outcomes including duration of fever after re-operation (0.95 ± 1.13 vs 4.07 ± 5.35, P = 0.001), positive organism results (14 of 19 vs 2 of 15, P < 0.01), and VAS at 3 days after re-operation (2.58 ± 0.69 vs 3.40 ± 1.06, P < 0.05). Patients in NPWT group exhibited significant decrease in implant infection recurrence (0 of 19 vs 5 of 15, P < 0.01), implant retention rate (19 of 19 vs 10 of 15, P < 0.01), duration of hospitalization (27.74 ± 10.95 vs 37.67 ± 13.67, P < 0.01). CONCLUSIONS NPWT is a feasible and safe treatment option for deep SSI after posterior instrumented spinal surgery.
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Affiliation(s)
- Jingming Wang
- Department of Orthopedics, 960Th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China
| | - Yang Yang
- Department of Orthopedics, 960Th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China
| | - Wenqiang Xing
- Department of Orthopedics, 960Th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China
| | - Hao Xing
- Department of Orthopedics, 960Th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China
| | - Yun Bai
- Department of Orthopedics, 960Th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China
| | - Zhengqi Chang
- Department of Orthopedics, 960Th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China.
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White AJ, Gilad R, Motivala S, Fiani B, Rasouli J. Negative Pressure Wound Therapy in Spinal Surgery. Bioengineering (Basel) 2022; 9:614. [PMID: 36354525 PMCID: PMC9687616 DOI: 10.3390/bioengineering9110614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 10/30/2023] Open
Abstract
Negative pressure wound therapy (NPWT) has demonstrated promise in the management of surgical site infections as well as assisting in surgical wound healing. In this manuscript, we describe the mechanisms and applications of NPWT for surgical wounds and existing evidence for NPWT in cardiac, plastic, and general surgery, followed by a discussion of the emerging evidence base for NPWT in spinal surgery. We also discuss the different applications of NPWT for open wounds and closed incisions, and the promise of newer closed-incision NPWT (ciNPWT) devices. There is nominal but promising prospective evidence on NPWT's efficacy in select at-risk populations for post-operative wound complications after spinal surgery. As there is currently a paucity of robust clinical evidence on its efficacy, rigorous randomized prospective clinical trials are needed.
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Affiliation(s)
- Alexandra Jeanne White
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH 44195, USA
| | - Ronit Gilad
- Northwell Health—Staten Island University Hospital, Staten Island, NY 10301, USA
| | - Soriaya Motivala
- Northwell Health—Staten Island University Hospital, Staten Island, NY 10301, USA
| | - Brian Fiani
- Department of Neurosurgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY 10065, USA
| | - Jonathan Rasouli
- Northwell Health—Staten Island University Hospital, Staten Island, NY 10301, USA
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14
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The Utility of Closed Incision Negative Pressure Wound Therapy following Spinal Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 168:258-267.e1. [PMID: 36116727 DOI: 10.1016/j.wneu.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine if closed incision negative pressure wound therapy (ciNPWT) decreases surgical site infection (SSI) or wound dehiscence following spinal fusion. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic review and meta-analysis was conducted to identify studies utilizing ciNPWT following spinal fusion. Funnel plots and quality scores of the articles were performed to determine if the articles were at risk of bias. Forest plots were conducted to identify the treatment effect of ciNPWT following spinal fusion. RESULTS A total of 8 studies comprising 1,061 patients who received ciNPWT or a standard postoperative dressing following spinal fusion were included. The rate of SSI [ciNPWT: 4.49% (95% CI: 2.48, 8.00) vs. control: 11.32% (95% CI: 7.51, 16.70), p=0.0103] was significantly lower for patients treated with ciNPWT. A fixed-effects model showed no significant difference between patients who received ciNWPT or a standard postoperative dressing with respect to requiring reoperations for wound debridement (OR: 1.25, 95% CI: 0.64, 2.41). Additionally, wound dehiscence was not significantly different between the two groups although it was non-significantly lower in ciNWPT-treated patients [ciNPWT: 4.59% (95% CI: 2.49, 8.31) vs control: 7.48% (95% CI: 4.38, 12.47), p=0.23]. CONCLUSION Closed incision NPWT may reduce the rates of SSI following spinal fusion. The use of ciNWPT may also significantly reduce the burden associated with postoperative wound complications, but the meta-analysis was insufficiently powered to make this association. Additional, studies may identify a subset of patients who benefit from ciNPWT for other wound-related complications.
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15
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Khan SA, Choudry UK, Salim A, Nathani KR, Enam SA, Shehzad N. Current management trends for surgical site infection after posterior lumbar spinal instrumentation. A systematic review. World Neurosurg 2022; 164:374-380. [PMID: 35671992 DOI: 10.1016/j.wneu.2022.05.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Abstract
STUDY DESIGN Systematic review OBJECTIVE: The objective of this systematic review is to determine the fate of spinal implants when the patients develop postoperative wound infection after posterior instrumental fusion in a degenerative spine. METHODS A systematic review of the English-language literature (published between January 2001 and July 2020) was undertaken to identify articles documenting the management strategy for surgical-site infections after posterior lumbar spinal fusion. Studies on pedicle screw fixation after trauma, immunocompromised, metastatic spine disease, and combined anterior/posterior approach were excluded. Two independent reviewers assessed the level of evidence quality using the criteria set by the North American Spine Society, and disagreements were resolved by consensus. RESULTS Out of the 3,071 citations identified, 49 met the criteria to undergo full-text review. Outcomes after surgical site infections were studied from a combined pool of 1,150 patients undergone instrumental spinal fusion. The collected data showed that 456 patients (39.97%) had undergone spinal implant removal following SSI while 694 patients (60.03%) had their implants retained until the resolution of SSI. There was an absolute risk reduction of 29% (ARR-0.292) and a relative risk reduction of 50.3% (RRR- 0.503) of implant removal if the patient underwent wound debridement following SSI. The NNT for wound debridement was calculated at 3.31 from our pooled cohort. The absolute risk reduction in implant removal following VAC therapy was 16.6% and relative risk reduction was noted at 40.4%. This led to a high value of NNT at 6.0 patients. There was an absolute risk reduction of 33.5% while a Relative Risk Reduction of 70.7% was estimated in patients undergoing continuous irrigation. CONCLUSION Our review of the literature suggests that successful eradication of surgical site infection after posterior lumbar spinal fusion can be achieved by wound debridement or VAC therapy with appropriate antimicrobial coverage in most cases. Implant removal is generally reserved for cases refractory to the other treatment modalities.
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Affiliation(s)
| | | | - Adnan Salim
- Department of Neurosurgery, Aga Khan University Hospital.
| | | | | | - Noman Shehzad
- Department of Surgery, Yorkshire and Humber Deanery.
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16
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Can prophylactic negative pressure wound therapy improve clinical outcomes in spinal fusion surgery? A meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1546-1552. [PMID: 35306599 DOI: 10.1007/s00586-022-07178-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Recently negative pressure wound therapy (NPWT) is increasingly being prophylactically used to prevent wound complications in various types of surgeries, but its role in spinal fusion surgery was less well established. This study aimed to evaluate the efficacy of prophylactic NPWT (PNPWT) usage in spinal fusion surgery. METHODS Following PRISMA guidelines, databases PubMed, Embase and Web of Science were searched for relevant studies. Studies comparing PNPWT with standard wound dressing (SWD) were included and analyzed. The primary outcome was the incidence of surgical site infection, and secondary outcomes were incidence of wound dehiscence, overall wound complication, readmission and reoperation. RESULTS A total of five studies were included; there were 279 patients in PNPWT group and 715 patients in SWD group. Four studies investigated surgical site infection; the pooled analysis showed a significantly lower incidence of surgical site infection in PNPWT group (OR: 0.399; 95% CI: 0.198, 0.802). Two studies explored wound dehiscence, three studies reported overall wound complication, and there were no significant differences between the two groups ((OR: 0.448; 95% CI: 0.144, 1.389) and (OR: 0.562; 95% CI: 0.296, 1.065), respectively). Two studies evaluated readmission, three studies compared reoperation rate, and the pooled results demonstrated no significant difference between the two groups ((OR: 1.045; 95% CI: 0.536, 2.038) and (OR: 0.979; 95% CI: 0.442, 2.169), respectively). CONCLUSIONS The current evidence suggested PNPWT could effectively reduce postoperative surgical site infection, but it had no significant benefit on reducing the incidence of wound dehiscence, overall wound complication, readmission and reoperation.
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Vidalis BM, Ngwudike SI, McCandless MG, Chohan MO. Negative Pressure Wound Therapy in Facilitating Wound Healing after Surgical Decompression for Metastatic Spine Disease. World Neurosurg 2021; 159:e407-e415. [PMID: 34954060 DOI: 10.1016/j.wneu.2021.12.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The risk of wound related complications, including surgical site infections (SSIs), in patients undergoing surgery for metastatic spine disease (MSD) is high. Consequently, patients requiring wound revision surgery face delay in resuming oncological care and incur additional hospitalization. Recent reports suggest that negative pressure wound therapy (NPWT) applied on a closed wound at the time of surgery, significantly reduces post-operative wound complications in degenerative spine disease and trauma setting. Here, we report a single institution experience with incisional NPWT in patients undergoing surgery for MSD. METHODS We compared rates of wound complications requiring surgical revision in a surgical cohort of patients with or without NPWT from 2015 to 2020. Adult patients with radiographic evidence of MSD with mechanical instability and/or accelerated neurological decline were included in the study. NPWT was applied on a closed wound in the operating room and continued for 5 days or until discharge, whichever occurred first. RESULTS A total of 42 patients were included: 28 with NPWT and 14 without. Patient demographics including underlying comorbidities were largely similar. NPWT patients had higher rates of prior radiation to the surgical site (36% vs. 0%, p = 0.017) and longer fusion constructs (6.7 vs. 3.9 levels, p < 0.001). Three patients (21%) from control group and none from NPWT group contracted SSI requiring wound washout (p = 0.032). CONCLUSIONS Our data suggests that SSI and wound dehiscence are significantly reduced with the addition of incisional NPWT in in this vulnerable population.
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Affiliation(s)
- Benjamin M Vidalis
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131
| | | | - Martin G McCandless
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS 39216
| | - Muhammad O Chohan
- Department of Neurosurgery, University of New Mexico, Albuquerque, NM 87131; Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS 39216.
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Cai Y, Zhang T, Xiong N. Letter: Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on the Development of Surgical Site Infection After Spinal Surgery: A Prospective Observational Study. Neurosurgery 2021; 89:E341-E342. [PMID: 34498694 DOI: 10.1093/neuros/nyab350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yuankun Cai
- Department of Neurosurgery Zhongnan Hospital of Wuhan University Wuhan, P.R. China
| | - TingBao Zhang
- Department of Neurosurgery Zhongnan Hospital of Wuhan University Wuhan, P.R. China
| | - Nanxiang Xiong
- Department of Neurosurgery Zhongnan Hospital of Wuhan University Wuhan, P.R. China
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Akhter AS, McGahan BG, Close L, Dornbos D, Toop N, Thomas NR, Christ E, Dahdaleh NS, Grossbach AJ. Negative pressure wound therapy in spinal fusion patients. Int Wound J 2020; 18:158-163. [PMID: 33236841 PMCID: PMC8243993 DOI: 10.1111/iwj.13507] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/14/2020] [Accepted: 09/21/2020] [Indexed: 12/12/2022] Open
Abstract
Post-operative wound complications are some of the most common acute complications following spine surgery. These surgical site infections (SSI) contribute to increased healthcare related costs. Negative pressure wound therapy (NPWT) has long been used for treatment of soft tissue injury or defects. NPWT may reduce the incident of SSI following spinal fusion procedures; however, its potential applications need further clarification. Thus, we conducted a retrospective analysis of two cohorts to compare NPWT to traditional sterile dressings following spinal fusions in regards to post-operative outcomes. Following institutional review board approval, 42 patients who had a NPWT were matched by type of surgery to 42 patients who had traditional dressings. A retrospective chart-review was completed. Outcome measures, particularly SSI and need for reoperation, were analyzed using one-way ANOVA for both univariate and multivariate analysis. When controlled for sex and body-mass index, the use of a NPWT was independently correlated with decreased SSI (P = .035). Superficial dehiscence, seroma, need for additional outpatient care, and need for operative revision were all found to occur at higher rates in the traditional dressing cohort. Closed incisional negative pressure wound therapy provides a cost-effective method of decreasing surgical site infection for posterior elective spine surgeries.
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Affiliation(s)
- Asad S Akhter
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Benjamin G McGahan
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Liesl Close
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - David Dornbos
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nathaniel Toop
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nicholas R Thomas
- School of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Elizabeth Christ
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nader S Dahdaleh
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andrew J Grossbach
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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