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Safety and efficacy of negative pressure wound therapy in treating deep surgical site infection after lumbar surgery

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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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Data availability

All data analyzed during this study are included in the manuscript. The datasets used in this article are available from the corresponding author (Z.Q.C.) on reasonable request.

References

  1. Abdul-Jabbar A, Takemoto S, Weber MH, Hu SS, Mummaneni PV, Deviren V, Ames CP, Chou D, Weinstein PR, Burch S, Berven SH (2012) Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data. Spine (Phila Pa 1976) 37:1340–1345. https://doi.org/10.1097/BRS.0b013e318246a53a

    Article  Google Scholar 

  2. Shoji H, Hirano T, Watanabe K, Ohashi M, Mizouchi T, Endo N (2018) Risk factors for surgical site infection following spinal instrumentation surgery. J Orthop Sci 23:449–454. https://doi.org/10.1016/j.jos.2018.02.008

    Article  PubMed  Google Scholar 

  3. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, Dudeck MA, Pollock DA, Horan TC (2009) National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 37:783–805. https://doi.org/10.1016/j.ajic.2009.10.001

    Article  PubMed  Google Scholar 

  4. Anderson DJ, Kaye KS, Classen D, Arias KM, Podgorny K, Burstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS (2008) Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol 29(Suppl 1):S51-61. https://doi.org/10.1086/591064

    Article  PubMed  Google Scholar 

  5. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB (2009) Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 37:387–397. https://doi.org/10.1016/j.ajic.2008.12.010

    Article  PubMed  Google Scholar 

  6. Fei Q, Li J, Lin J, Li D, Wang B, Meng H, Wang Q, Su N, Yang Y (2016) Risk factors for surgical site infection after spinal surgery: a meta-analysis. World Neurosurg 95:507–515. https://doi.org/10.1016/j.wneu.2015.05.059

    Article  PubMed  Google Scholar 

  7. Pesenti S, Pannu T, Andres-Bergos J, Lafage R, Smith JS, Glassman S, de Kleuver M, Pellise F, Schwab F, Lafage V, Scoliosis Research S (2018) What are the risk factors for surgical site infection after spinal fusion? A meta-analysis. Eur Spine J 27:2469–2480. https://doi.org/10.1007/s00586-018-5733-7

    Article  PubMed  Google Scholar 

  8. Peng XQ, Sun CG, Fei ZG, Zhou QJ (2019) Risk factors for surgical site infection after spinal surgery: a systematic review and meta-analysis based on twenty-seven studies. World Neurosurg 123:e318–e329. https://doi.org/10.1016/j.wneu.2018.11.158

    Article  PubMed  Google Scholar 

  9. Mok JM, Guillaume TJ, Talu U, Berven SH, Deviren V, Kroeber M, Bradford DS, Hu SS (2009) Clinical outcome of deep wound infection after instrumented posterior spinal fusion: a matched cohort analysis. Spine (Phila Pa 1976) 34:578–583. https://doi.org/10.1097/BRS.0b013e31819a827c

    Article  Google Scholar 

  10. Garner BH, Anderson DJ (2016) Surgical site infections: an update. Infect Dis Clin North Am 30:909–929. https://doi.org/10.1016/j.idc.2016.07.010

    Article  PubMed  Google Scholar 

  11. Jones GA, Butler J, Lieberman I, Schlenk R (2007) Negative-pressure wound therapy in the treatment of complex postoperative spinal wound infections: complications and lessons learned using vacuum-assisted closure. J Neurosurg Spine 6:407–411. https://doi.org/10.3171/spi.2007.6.5.407

    Article  PubMed  Google Scholar 

  12. Ploumis A, Mehbod AA, Dressel TD, Dykes DC, Transfeldt EE, Lonstein JE (2008) Therapy of spinal wound infections using vacuum-assisted wound closure: risk factors leading to resistance to treatment. J Spinal Disord Tech 21:320–323. https://doi.org/10.1097/BSD.0b013e318141f99d

    Article  PubMed  Google Scholar 

  13. Rohmiller MT, Akbarnia BA, Raiszadeh K, Raiszadeh K, Canale S (2010) Closed suction irrigation for the treatment of postoperative wound infections following posterior spinal fusion and instrumentation. Spine (Phila Pa 1976) 35:642–646. https://doi.org/10.1097/BRS.0b013e3181b616eb

    Article  Google Scholar 

  14. Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426. https://doi.org/10.1097/00002517-200010000-00009

    Article  CAS  PubMed  Google Scholar 

  15. Zeng J, Sun X, Sun Z, Guan J, Han C, Zhao X, Zhang P, Xie Y, Zhao J (2019) Negative pressure wound therapy versus closed suction irrigation system in the treatment of deep surgical site infection after lumbar surgery. World Neurosurg 127:e389–e395. https://doi.org/10.1016/j.wneu.2019.03.130

    Article  PubMed  Google Scholar 

  16. Akhter AS, McGahan BG, Close L, Dornbos D 3rd, Toop N, Thomas NR, Christ E, Dahdaleh NS, Grossbach AJ (2021) Negative pressure wound therapy in spinal fusion patients. Int Wound J 18:158–163. https://doi.org/10.1111/iwj.13507

    Article  PubMed  Google Scholar 

  17. Lian XF, Xu JG, Zeng BF, Liu XK, Li H, Qiu ML, Yang EZ (2014) Continuous irrigation and drainage for early postoperative deep wound infection after posterior instrumented spinal fusion. J Spinal Disord Tech 27:E315-317. https://doi.org/10.1097/BSD.0000000000000122

    Article  PubMed  Google Scholar 

  18. Shah A, Sumpio BJ, Tsay C, Swallow M, Dash B, Thorn SL, Sinusas AJ, Koo A, Hsia HC, Au A (2019) Incisional negative pressure wound therapy augments perfusion and improves wound healing in a swine model pilot study. Ann Plast Surg 82:S222–S227. https://doi.org/10.1097/SAP.0000000000001842

    Article  CAS  PubMed  Google Scholar 

  19. Dyck BA, Bailey CS, Steyn C, Petrakis J, Urquhart JC, Raj R, Rasoulinejad P (2019) Use of incisional vacuum-assisted closure in the prevention of postoperative infection in high-risk patients who underwent spine surgery: a proof-of-concept study. J Neurosurg Spine 31:430–439. https://doi.org/10.3171/2019.2.SPINE18947

    Article  PubMed  Google Scholar 

  20. Bible JE, Biswas D, Devin CJ (2011) Postoperative infections of the spine. Am J Orthop (Belle Mead NJ) 40:E264-271

    Google Scholar 

  21. Meredith DS, Kepler CK, Huang RC, Brause BD, Boachie-Adjei O (2012) Postoperative infections of the lumbar spine: presentation and management. Int Orthop 36:439–444. https://doi.org/10.1007/s00264-011-1427-z

    Article  PubMed  Google Scholar 

  22. Deng H, Chan AK, Ammanuel S, Chan AY, Oh T, Skrehot HC, Edwards S, Kondapavulur S, Nichols AD, Liu C, Yue JK, Dhall SS, Clark AJ, Chou D, Ames CP, Mummaneni PV (2019) Risk factors for deep surgical site infection following thoracolumbar spinal surgery. J Neurosurg Spine 32:292–301. https://doi.org/10.3171/2019.8.SPINE19479

    Article  PubMed  Google Scholar 

  23. Barker FG 2nd (2002) Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis. Neurosurgery 51:391–400 (discussion 400-391)

    Article  Google Scholar 

  24. Brown MD, Brookfield KF (2004) A randomized study of closed wound suction drainage for extensive lumbar spine surgery. Spine (Phila Pa 1976) 29:1066–1068. https://doi.org/10.1097/00007632-200405150-00003

    Article  Google Scholar 

  25. De la Garza-Ramos R, Abt NB, Kerezoudis P, McCutcheon BA, Bydon A, Gokaslan Z, Bydon M (2016) Deep-wound and organ-space infection after surgery for degenerative spine disease: an analysis from 2006 to 2012. Neurol Res 38:117–123. https://doi.org/10.1080/01616412.2016.1138669

    Article  PubMed  Google Scholar 

  26. Canavese F, Gupta S, Krajbich JI, Emara KM (2008) Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis. J Bone Joint Surg Br 90:377–381. https://doi.org/10.1302/0301-620X.90B3.19890

    Article  CAS  PubMed  Google Scholar 

  27. Labler L, Keel M, Trentz O, Heinzelmann M (2006) Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery. Eur Spine J 15:1388–1396. https://doi.org/10.1007/s00586-006-0164-2

    Article  PubMed  PubMed Central  Google Scholar 

  28. Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A (2009) Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum 39:10–17. https://doi.org/10.1016/j.semarthrit.2008.03.002

    Article  CAS  PubMed  Google Scholar 

  29. Mendonca DA, Papini R, Price PE (2006) Negative-pressure wound therapy: a snapshot of the evidence. Int Wound J 3:261–271. https://doi.org/10.1111/j.1742-481X.2006.00266.x

    Article  PubMed  PubMed Central  Google Scholar 

  30. Vuerstaek JD, Vainas T, Wuite J, Nelemans P, Neumann MH, Veraart JC (2006) State-of-the-art treatment of chronic leg ulcers: a randomized controlled trial comparing vacuum-assisted closure (V.A.C.) with modern wound dressings. J Vasc Surg 44:1029–1037. https://doi.org/10.1016/j.jvs.2006.07.030 (discussion 1038)

    Article  PubMed  Google Scholar 

  31. Blumberg TJ, Woelber E, Bellabarba C, Bransford R, Spina N (2018) Predictors of increased cost and length of stay in the treatment of postoperative spine surgical site infection. Spine J 18:300–306. https://doi.org/10.1016/j.spinee.2017.07.173

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank Associate Professor Li Jianhua for his help with the English writing of our manuscript.

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Authors and Affiliations

  1. Department of Orthopedics, 960Th Hospital of PLA, Shifan road, Tianqiao district, Jinan, 250031, China

    Jingming Wang, Yang Yang, Wenqiang Xing, Hao Xing, Yun Bai & Zhengqi Chang

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Contributions

J.M.W. and Z.Q.C. made substantial contributions to acquisition, analysis, and interpretation of data. Z.Q.C. was responsible for the conception and design of the study and the drafting and writing of this manuscript. Y.Y., W.Q.X., and J.M.W. were a surgical assistant. All authors confirm the authenticity of all the raw data.

Corresponding author

Correspondence to Zhengqi Chang.

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This study has been approved by the 960th hospital of PLA. Each author certifies that all investigations were conducted in accordance with ethical principles. The participant involved in the study gave their informed consent and signed an informed consent form.

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Written consent to publish this article was obtained from study participants. Proof of consent to publish from study participants can be requested at any time.

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The authors declare no competing interests.

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Wang, J., Yang, Y., Xing, W. et al. Safety and efficacy of negative pressure wound therapy in treating deep surgical site infection after lumbar surgery. International Orthopaedics (SICOT) 46, 2629–2635 (2022). https://doi.org/10.1007/s00264-022-05531-w

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