新型伤口管理系统降低腹疝修补术后手术部位发病率的批判性分析
Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis.
作者信息
Soares Kevin C, Baltodano Pablo A, Hicks Caitlin W, Cooney Carisa M, Olorundare Israel O, Cornell Peter, Burce Karen, Eckhauser Frederic E
机构信息
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Am J Surg. 2015 Feb;209(2):324-32. doi: 10.1016/j.amjsurg.2014.06.022. Epub 2014 Aug 7.
BACKGROUND
Prophylactic incisional negative-pressure wound therapy use after ventral hernia repairs (VHRs) remains controversial. We assessed the impact of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) on outcomes of open VHR.
METHODS
A 5-year retrospective analysis of all VHRs performed by a single surgeon at a single institution compared outcomes after HVAC versus standard wound dressings. Multivariable logistic regression compared surgical site infections, surgical site occurrences, morbidity, and reoperation rates.
RESULTS
We evaluated 199 patients (115 HVAC vs 84 standard wound dressing patients). Mean follow-up was 9 months. The HVAC cohort had lower surgical site infections (9% vs 32%, P < .001) and surgical site occurrences (17% vs 42%, P = .001) rates. Rates of major morbidity (19% vs 31%, P = .04) and 90-day reoperation (5% vs 14%, P = .02) were lower in the HVAC cohort.
CONCLUSIONS
The HVAC system is associated with optimized outcomes following open VHR. Prospective studies should validate these findings and define the economic implications of this intervention.
背景
腹疝修补术（VHR）后预防性使用切口负压伤口治疗仍存在争议。我们评估了一种改良的负压伤口治疗系统（混合式负压封闭引流或HVAC）对开放性VHR结局的影响。
方法
对单一机构中由单一外科医生实施的所有VHR进行为期5年的回顾性分析，比较HVAC治疗与标准伤口敷料治疗后的结局。多变量逻辑回归比较手术部位感染、手术部位事件、发病率和再次手术率。
结果
我们评估了199例患者（115例接受HVAC治疗，84例接受标准伤口敷料治疗）。平均随访时间为9个月。HVAC组的手术部位感染率（9%对32%，P <.001）和手术部位事件发生率（17%对42%，P =.001）较低。HVAC组的严重发病率（19%对31%，P =.04）和90天再次手术率（5%对14%，P =.02）也较低。
结论
HVAC系统与开放性VHR后的优化结局相关。前瞻性研究应验证这些发现并确定该干预措施的经济影响。
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