The John L. Cameron Division of Hepatobiliary and Pancreatic Surgery, The Johns Hopkins Hospital, Baltimore, MD.
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
Ann Surg. 2019 Jun;269(6):1034-1040. doi: 10.1097/SLA.0000000000003056.
This study seeks to evaluate the efficacy of negative pressure wound therapy for surgical-site infection (SSI) after open pancreaticoduodenectomy.
Despite improvement in infection control, SSIs remain a common cause of morbidity after abdominal surgery. SSI has been associated with an increased risk of reoperation, prolonged hospitalization, readmission, and higher costs. Recent retrospective studies have suggested that the use of negative pressure wound therapy can potentially prevent this complication.
We conducted a single-center randomized, controlled trial evaluating surgical incision closure during pancreaticoduodenectomy using negative pressure wound therapy in patients at high risk for SSI. We randomly assigned patients to receive negative pressure wound therapy or a standard wound closure. The primary end point of the study was the occurrence of a postoperative SSI. We evaluated the economic impact of the intervention.
From January 2017 through February 2018, we randomized 123 patients at the time of closure of the surgical incision. SSI occurred in 9.7% (6/62) of patients in the negative pressure wound therapy group and in 31.1% (19/61) of patients in the standard closure group (relative risk = 0.31; 95% confidence interval, 0.13-0.73; P = 0.003). This corresponded to a relative risk reduction of 68.8%. SSIs were found to independently increase the cost of hospitalization by 23.8%.
The use of negative pressure wound therapy resulted in a significantly lower risk of SSIs. Incorporating this intervention in surgical practice can help reduce a complication that significantly increases patient harm and healthcare costs.
本研究旨在评估负压伤口疗法在胰十二指肠切除术后手术部位感染（SSI）中的疗效。
尽管感染控制有所改善，但 SSI 仍然是腹部手术后发病率的常见原因。SSI 与再次手术、住院时间延长、再入院和更高成本的风险增加有关。最近的回顾性研究表明，负压伤口疗法的使用可能有助于预防这种并发症。
我们进行了一项单中心随机对照试验，评估了在胰十二指肠切除术中使用负压伤口疗法对高风险 SSI 患者的手术切口闭合情况。我们将患者随机分配接受负压伤口疗法或标准伤口闭合。该研究的主要终点是术后 SSI 的发生。我们评估了干预措施的经济影响。
从 2017 年 1 月至 2018 年 2 月，我们在手术切口关闭时随机分配了 123 名患者。负压伤口疗法组 9.7%（6/62）的患者发生 SSI，标准闭合组 31.1%（19/61）的患者发生 SSI（相对风险=0.31；95%置信区间，0.13-0.73；P=0.003）。这相当于相对风险降低了 68.8%。SSI 被发现独立增加了 23.8%的住院费用。
使用负压伤口疗法可显著降低 SSI 的风险。将这种干预措施纳入手术实践中有助于减少显著增加患者伤害和医疗成本的并发症。
