Buckarma EeeLN, Rivera Mariela, Schiller Henry, Loomis Erica
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
J Surg Res. 2018 Dec;232:643-646. doi: 10.1016/j.jss.2018.07.065. Epub 2018 Aug 17.
Treatment of cardiovascular implantable device pocket infections (CIDPIs) requires a multimodal approach that includes antimicrobials, device explantation, and local wound care. Our institution implemented a practice management guideline (PMG) to standardize the care of CIDPIs and engage our acute care surgeons in 2013. Our PMG includes wound culture, complete capsulectomy, pulse lavage, and the placement of a negative pressure wound therapy appliance at the time of device extraction. Forty-eight hours later, wounds are irrigated and closed in a delayed primary fashion over drains. Our objective was to compare the outcomes of patients who underwent device extraction before and after the implementation of the PMG for the treatment of CIDPIs.
An IRB-approved retrospective review of 155 patients at our institution from 2012 to 2015 who underwent device explantation. Evaluated outcomes measured included days from device explant to wound closure, and postoperative complications. Outcomes data were analyzed before (pre-PMG) and after (post-PMG) enactment of the PMG.
Fifty-eight patients (42 males; mean age 68 years) were managed prior to PMG implementation; 97 (72 males; mean age 67) were managed after. Mean days from device explantation to wound closure were compared (pre-PMG 6 ± 3.5 and post-PMG 2.8 ± 1.8), and time to closure was reduced by 3-d post-PMG implementation (P < 0.05). No increase in surgical site infection, hematoma, or unplanned return to operating room was demonstrated between groups (P < 0.05).
The implementation of a PMG for the management of CIDPIs is effective in reducing the number of days to pocket wound closure; acute care surgeons are well equipped to participate in this practice and improve patient outcomes.
心血管植入式设备囊袋感染（CIDPIs）的治疗需要采取多模式方法，包括使用抗菌药物、取出设备以及局部伤口护理。我们机构于2013年实施了一项实践管理指南（PMG），以规范CIDPIs的护理，并让我们的急性 care 外科医生参与其中。我们的PMG包括伤口培养、完整的囊袋切除术、脉冲冲洗以及在取出设备时放置负压伤口治疗装置。48小时后，伤口进行冲洗，并通过延迟一期缝合的方式在引流管上进行闭合。我们的目的是比较在实施PMG前后接受设备取出治疗CIDPIs的患者的结局。
对2012年至2015年在我们机构接受设备取出的155例患者进行了一项经机构审查委员会批准的回顾性研究。评估的结局指标包括从设备取出到伤口闭合的天数以及术后并发症。在PMG颁布之前（PMG前）和之后（PMG后）对结局数据进行分析。
在实施PMG之前管理了58例患者（42例男性；平均年龄68岁）；之后管理了97例（72例男性；平均年龄67岁）。比较了从设备取出到伤口闭合的平均天数（PMG前6±3.5天和PMG后2.8±1.8天），实施PMG后闭合时间缩短了3天（P<0.05）。两组之间未显示手术部位感染、血肿或计划外返回手术室的情况增加（P<0.05）。
实施用于管理CIDPIs的PMG可有效减少囊袋伤口闭合的天数；急性 care 外科医生具备充分能力参与此项实践并改善患者结局。
