NPWT may not aid in prevention of deep infection after hip, pelvic and acetabular fracture surgery

TAMPA, Fla. — Results of a prospective randomized trial indicate acute negative pressure wound therapy does not decrease the risk of infection in patients who undergo open reduction and internal fixation of acetabular, pelvic or hip fractures compared with standard gauze dressings.

“Negative pressure wound therapy [NPWT] does not appear to decrease risk of infection, and there may be certain patients who are at risk to get deep infection including those with posterior wall or column involvement in acetabular fracture surgery requiring a Kocher approach and then those patients with specifically significant medical comorbidities,” Brett D. Crist, MD, FACS, said at the Orthopaedic Trauma Association Annual Meeting, here.

In their IRB-approved study, Crist and his colleagues studied 115 patients randomized to either standard gauze dressings or at least 2 days of NPWT following fixation. A power analysis revealed 55 patients would be needed in each group to show a significant difference for rates of deep infection.

The NPWT group included 55 patients and 49 patients completed 12-month follow-up. The standard gauze group included 60 patients, of which 41 patients completed follow-up.  Most of the patients in both groups had acetabular fractures, and investigators found no significant difference between the groups in the rate of deep infection.

Five of 49 patients in the NPWT group had deep infections vs. two of 41 patients in the gauze group “which obviously might be a power issue,” Crist said. “But the odds ratio did show that negative pressure wound therapy patients were 2.3-times more likely to develop a deep infection.”

He added, “There may be a couple of variables that show there is an increased risk of infection with certain patients and so the acetabular fracture patients were the majority of patients, and all of the deep infections occurred in the acetabular fracture patients who had posterior wall or column involved and underwent a Kocker approach for ORIF.”

Six of the seven patients who fell in this category had medical co-morbidities.

“In our series, BMI was not associated with an increased risk of infection,” Crist said. Patients who had deep infections had longer stays in the ICU, Crist noted “which meant overall that they were sicker, although the ISS was not different amongst the patients.” These patients also had longer hospital stays.

“Does NPT decrease deep infection in these patients? Maybe not. Although it was not statistically significant, there were patients who were at higher risk, including those patients who had acetabular fractures that had posterior wall or column involvement requiring a Kocker approach,” he said. — by Gina Brockenbrough, MA

Reference:

Crist BD. Paper #65. Presented at: Orthopaedic Trauma Association Annual Meeting; Oct. 16-18, 2014; Tampa, Fla.

Disclosure: Crist a consultant for KCI, but was not during most of this project. He and his institution received nothing from the company for this study.