Skip to main content

Advertisement

SpringerLink
Log in

S116: Impact of incisional negative pressure wound therapy on surgical site infection after complex incisional hernia repair: a retrospective matched cohort study

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Introduction

Incisional negative pressure wound therapy (iNPWT) may reduce surgical site infections (SSI), which can have devastating consequences after incisional hernia repair. Few comparative studies investigate the effectiveness of this wound management strategy in this population. The objective of this study is to determine the effect of iNPWT on the incidence of SSI after complex incisional hernia repair.

Methods

All adult patients undergoing open incisional hernia repair at a single center from 2016 to 2019 were reviewed. A commercial iNPWT dressing was used at the discretion of the surgeon. Patients were grouped by type of dressing; iNPWT and standard sterile dressings (SSD). Coarsened exact matching was used to create balanced cohorts for comparison using age, sex, American Society of Anesthesiologists classification, wound classification, and surgical urgency. The primary outcome was the composite incidence of superficial and deep SSI within 30 days. Secondary outcomes included non-infectious surgical site occurrences (SSO), overall complications, length of stay (LOS), emergency department visits, and readmission at 30 days.

Results

134 patients underwent complex hernia repair, with 114 patients included after matching (34 iNPWT, 51 SSD). Composite incidence of superficial and deep SSI was 19.3% (11.8% vs. 27.5%, p = 0.107), with significantly lower rates of deep SSI in patients receiving iNPWT (2.9% vs. 17.6%, p = 0.045). After accounting for residual differences between groups, iNPWT was associated with decreased incidence of composite SSI (RR 0.36, 95% CI [0.16, 0.87]). Median LOS was longer in patients with iNPWT (7 vs. 5 days, p = 0.001). There were no differences in SSO, overall complications, readmission, or emergency department visits.

Conclusion

In patients undergoing incisional hernia repair, the use of iNPWT was associated with a lower incidence of SSI at 30 days. Future studies should focus on cost effectiveness of iNPWT, its impact on long-term hernia recurrences, and the identification of patient selection criteria in this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ventral Hernia Working G, Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF, Rosen M, Silverman RP, Vargo D (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558

    Article  Google Scholar 

  2. Kanters AE, Krpata DM, Blatnik JA, Novitsky YM, Rosen MJ (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215:787–793

    Article  Google Scholar 

  3. Iqbal CW, Pham TH, Joseph A, Mai J, Thompson GB, Sarr MG (2007) Long-term outcome of 254 complex incisional hernia repairs using the modified Rives-Stoppa technique. World J Surg 31:2398–2404

    Article  Google Scholar 

  4. Lauren Paton B, Novitsky YW, Zerey M, Sing RF, Kercher KW, Todd Heniford B (2007) Management of infections of polytetrafluoroethylene-based mesh. Surg Infect 8:337–342

    Article  Google Scholar 

  5. Cox TC, Blair LJ, Huntington CR, Colavita PD, Prasad T, Lincourt AE, Heniford BT, Augenstein VA (2016) The cost of preventable comorbidities on wound complications in open ventral hernia repair. J Surg Res 206:214–222

    Article  Google Scholar 

  6. Plymale MA, Ragulojan R, Davenport DL, Roth JS (2017) Ventral and incisional hernia: the cost of comorbidities and complications. Surg Endosc 31:341–351

    Article  Google Scholar 

  7. Rosen MJ, Bauer JJ, Harmaty M, Carbonell AM, Cobb WS, Matthews B, Goldblatt MI, Selzer DJ, Poulose BK, Hansson BME, Rosman C, Chao JJ, Jacobsen GR (2017) Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Ann Surg 265:205–211

    Article  Google Scholar 

  8. Dumville JC, Owens GL, Crosbie EJ, Peinemann F, Liu Z (2015) Negative pressure wound therapy for treating surgical wounds healing by secondary intention. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD011278.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hyldig N, Birke-Sorensen H, Kruse M, Vinter C, Joergensen JS, Sorensen JA, Mogensen O, Lamont RF, Bille C (2016) Meta-analysis of negative-pressure wound therapy for closed surgical incisions. Br J Surg 103:477–486

    Article  CAS  Google Scholar 

  10. Webster J, Liu Z, Norman G, Dumville JC, Chiverton L, Scuffham P, Stankiewicz M, Chaboyer WP (2019) Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009261.pub3

    Article  PubMed  PubMed Central  Google Scholar 

  11. World Health Organization (2018) Global guidelines for the prevention of surgical site infections. World Health Organization, Geneva

    Google Scholar 

  12. Chopra K, Gowda AU, Morrow C, Holton L 3rd, Singh DP (2016) The economic impact of closed-incision negative-pressure therapy in high-risk abdominal incisions: a cost-utility analysis. Plast Reconstr Surg 137:1284–1289

    Article  CAS  Google Scholar 

  13. Slater NJ, Montgomery A, Berrevoet F, Carbonell AM, Chang A, Franklin M, Kercher KW, Lammers BJ, Parra-Davilla E, Roll S, Towfigh S, van Geffen E, Conze J, van Goor H (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18:7–17

    Article  CAS  Google Scholar 

  14. Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang MK (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217:974–982

    Article  Google Scholar 

  15. Liang MK, Goodenough CJ, Martindale RG, Roth JS, Kao LS (2015) External validation of the ventral hernia risk score for prediction of surgical site infections. Surg Infect 16:36–40

    Article  Google Scholar 

  16. Centers for Disease C (2019) National Healthcare Safety Network Surveillance (NHSN) Patient Safety Component Manual 2019

  17. Centers for Disease C (2016) 2014 National and State Healthcare associated infections progress report. Centers for Disease Control

  18. Iacus, M S, King, Gary, Porro, Giuseppe (2018) cem: coarsened exact matching

  19. Stevens GA, King G, Shibuya K (2010) Deaths from heart failure: using coarsened exact matching to correct cause-of-death statistics. Popul Health Metr 8:6

    Article  Google Scholar 

  20. Wells AR, Hamar B, Bradley C, Gandy WM, Harrison PL, Sidney JA, Coberley CR, Rula EY, Pope JE (2013) Exploring robust methods for evaluating treatment and comparison groups in chronic care management programs. Popul Health Manag 16:35–45

    Article  Google Scholar 

  21. Blackwell M, Iacus S, King G, Porro G (2009) Cem: coarsened exact matching in stata. Stata J 9:524–546

    Article  Google Scholar 

  22. Tran BNN, Johnson AR, Shen C, Lee BT, Lee ES (2019) Closed-incision negative-pressure therapy efficacy in abdominal wall reconstruction in high-risk patients: a meta-analysis. J Surg Res 241:63–71

    Article  Google Scholar 

  23. Sahebally SM, McKevitt K, Stephens I, Fitzpatrick F, Deasy J, Burke JP, McNamara D (2018) Negative pressure wound therapy for closed laparotomy incisions in general and colorectal surgery: a systematic review and meta-analysis. JAMA Surg 153:e183467

    Article  Google Scholar 

  24. Xia C-Y, Yu A-X, Qi B, Zhou M, Li Z-H, Wang W-Y (2014) Analysis of blood flow and local expression of angiogenesis-associated growth factors in infected wounds treated with negative pressure wound therapy. Mol Med Rep 9:1749–1754

    Article  CAS  Google Scholar 

  25. Wilkes RP, Kilpad DV, Zhao Y, Kazala R, McNulty A (2012) Closed incision management with negative pressure wound therapy (CIM): biomechanics. Surg Innov 19:67–75

    Article  Google Scholar 

  26. Vargo D (2012) Negative pressure wound therapy in the prevention of wound infection in high risk abdominal wound closures. Am J Surg 204:1021–1023

    Article  Google Scholar 

  27. Gassman A, Mehta A, Bucholdz E, Abthani A, Guerra O, Maclin MM Jr, Esposito T, Thomas C (2015) Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates. Hernia 19:273–278

    Article  CAS  Google Scholar 

  28. de Vries FEE, Atema JJ, Lapid O, Obdeijn MC, Boermeester MA (2017) Closed incision prophylactic negative pressure wound therapy in patients undergoing major complex abdominal wall repair. Hernia 21:583–589

    Article  Google Scholar 

  29. Soares KC, Baltodano PA, Hicks CW, Cooney CM, Olorundare IO, Cornell P, Burce K, Eckhauser FE (2015) Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis. Am J Surg 209:324–332

    Article  Google Scholar 

  30. Pauli EM, Krpata DM, Novitsky YW, Rosen MJ (2013) Negative pressure therapy for high-risk abdominal wall reconstruction incisions. Surg Infect 14:270–274

    Article  Google Scholar 

  31. Condé-Green A, Chung TL, Holton LH 3rd, Hui-Chou HG, Zhu Y, Wang H, Zahiri H, Singh DP (2013) Incisional negative-pressure wound therapy versus conventional dressings following abdominal wall reconstruction: a comparative study. Ann Plast Surg 71:394–397

    Article  Google Scholar 

  32. Mehdorn M, Niebisch S, Scheuermann U, Gockel I, Jansen-Winkeln B (2019) Incisional negative pressure wound therapy does not reduce surgical site infections in abdominal midline incisions: a case control study. Acta Chir Belg. https://doi.org/10.1080/00015458.2019.1599180

    Article  PubMed  Google Scholar 

  33. Diaconu SC, McNichols CHL, Ngaage LM, Liang Y, Ikheloa E, Bai J, Grant MP, Nam AJ, Rasko YM (2018) Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy. Hernia 24(1):49–55

    Article  Google Scholar 

  34. Hicks CW, Poruk KE, Baltodano PA, Soares KC, Azoury SC, Cooney CM, Cornell P, Eckhauser FE (2016) Long-term outcomes of sandwich ventral hernia repair paired with hybrid vacuum-assisted closure. J Surg Res 204:282–287

    Article  Google Scholar 

  35. Rodriguez-Unda N, Soares KC, Azoury SC, Baltodano PA, Hicks CW, Burce KK, Cornell P, Cooney CM, Eckhauser FE (2015) Negative-pressure wound therapy in the management of high-grade ventral hernia repairs. J Gastrointest Surg 19:2054–2061

    Article  Google Scholar 

  36. Blackham AU, Farrah JP, McCoy TP, Schmidt BS, Shen P (2013) Prevention of surgical site infections in high-risk patients with laparotomy incisions using negative-pressure therapy. Am J Surg 205:647–654

    Article  Google Scholar 

  37. Murphy P, Kuper T, Ott M (2019) Negative pressure wound therapy for surgical site infection prevention requires further study before widespread adoption. JAMA Surg. https://doi.org/10.1001/jamasurg.2019.0428

    Article  PubMed  Google Scholar 

  38. Shen P, Blackham AU, Lewis S, Clark CJ, Howerton R, Mogal HD, Dodson RM, Russell GB, Levine EA (2017) Phase II randomized trial of negative-pressure wound therapy to decrease surgical site infection in patients undergoing laparotomy for gastrointestinal, pancreatic, and peritoneal surface malignancies. J Am Coll Surg 224:726–737

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave., L9.309, Montreal, QC, H3G 1A4, Canada

    Brent Hopkins, Jules Eustache, Pepa Kaneva, Gerald M. Fried, Kosar Khwaja, Melina Vassiliou, Paola Fata, Lawrence Lee & Liane S. Feldman

  2. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada

    Brent Hopkins, Jules Eustache, Gerald M. Fried, Kosar Khwaja, Melina Vassiliou, Paola Fata, Lawrence Lee & Liane S. Feldman

  3. Faculty of Medicine, McGill University, Montreal, QC, Canada

    Olivia Ganescu & Josie Cipolla

Authors
  1. Brent Hopkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jules Eustache
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olivia Ganescu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Josie Cipolla
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pepa Kaneva
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerald M. Fried
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kosar Khwaja
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Melina Vassiliou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Paola Fata
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Lawrence Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Liane S. Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lawrence Lee.

Ethics declarations

Disclosures

Dr. Feldman has received educational grants from Theator and Merck. Dr. Vassiliou has attended an educational course funded by KCI. Dr. Lee has received an investigator-initiated research grant from Johnson & Johnson. Drs. Hopkins, Eustaches, Fried, Khwaja, and Fata have no conflicts of interest or financial ties to disclose. Ms. Ganescu, Cipolla, and Kaneva have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hopkins, B., Eustache, J., Ganescu, O. et al. S116: Impact of incisional negative pressure wound therapy on surgical site infection after complex incisional hernia repair: a retrospective matched cohort study. Surg Endosc 35, 3949–3960 (2021). https://doi.org/10.1007/s00464-020-07857-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07857-1

Keywords

Search

Navigation