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Negative pressure wound therapy used in long-segment spine fusion helped decrease wound dehiscence

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SAN FRANCISCO — Investigators at Duke University Medical Center found a 10% rate of surgical site infection when negative pressure wound therapy was used in conjunction with wound closure compared to a 15% rate when it was not used in patients who underwent thoracolumbar fusions involving three or more levels.

Terence Verla, MPH, and colleagues retrospectively compared surgical site infection and wound dehiscence rates in the two groups of patients.

“There was a 50% decrease in the incidence of wound dehiscence in the patients who had negative pressure wound therapy (NPWT) compared to those who did not,” Verla said at the American Association of Neurological Surgeons Annual Meeting, here.

The wound dehiscence incidence with NPWT in the study was 6% compared to 12% when NPWT was not used, he said. The 46 patients who received NPWT treatment and the 114 patients who did not receive NPWT treatment were similar in age, smoking status, gender and BMI. Although Verla and colleagues detected an increased incidence of coronary artery disease in the non-NPWT cohort, they could not tell whether or not this factor was significant in the prediction of surgical site infection.

“There was no difference in the duration of index hospitalization in both cohorts and the message we are trying to drive here is we were not rushing the patients home because they had this negative pressure wound therapy. They both had a similar length of stay,” Verla said.

All wounds were closed similarly using absorbable sutures to close the fascia, skin staples or sutures for the skin closure and surgical dressings. The patients had drains put in for about 2 days, he said.

“In patients undergoing multisegment spine fusion we found that using NPWT, in our experience, was associated with superior clinical outcomes, with statistically significant lower incidence of [surgical site infection] SSI and wound dehiscence. However, larger multi-institutional randomized prospective controlled studies are needed to actually corroborate our findings,” Verla said. – by Susan M. Rapp

Reference:

Verla T. Paper #624. Presented at: American Association of Neurological Surgeons; April 5-9, 2014; San Francisco.

Disclosure: Verla has no relevant financial disclosures.