Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Division of GI and General Surgery, Emory University, Emory University, Atlanta, Georgia, USA.
Surg Infect (Larchmt). 2021 Jun;22(5):562-567. doi: 10.1089/sur.2020.183. Epub 2020 Nov 24.
The impact of negative pressure wound therapy (NPWT) as an adjunct to colorectal surgery is largely unknown. The purpose of this study was to determine whether NPWT impacts wound complications during elective open colectomy. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) and colectomy targeted procedure databases were queried from 2012-2018 for patients undergoing non-emergent planned open colectomies. Groups were propensity score matched for anastomosis type (ileo-colic, colo-colic, colo-rectal), age, body mass index (BMI), diabetes, smoking, steroid use, wound classification, American Society of Anesthesiologists (ASA) class, operative time, and wound layers closed. Wound complications were defined as superficial surgical site infection (SSI), deep incisional SSI, and dehiscence. A total of 15,770 patients were identified; 92 underwent simultaneous NPWT (0.58%). Non-NPWT patients were matched at a 5:1 ratio, producing 460 comparisons. There was no difference in wound complications (8.26% non-NPWT vs. 6.52% NPWT; p = 0.574). In addition, there were no differences in wound complications when only including patients who had NPWT placed over closed skin (9.11% non-NPWT vs. 7.25% NPWT; p = 0.789). On multivariable analysis, NPWT was not associated with wound complications (odds ratio [OR] 0.79; 95% confidence interval [CI], 0.37-1.69). Negative pressure wound therapy does not reduce wound complications in open elective colectomies. Large randomized studies and more granular data are needed to ascertain if there is any benefit in select patient populations.
负压伤口疗法（NPWT）作为结直肠手术的辅助手段的影响在很大程度上尚不清楚。本研究旨在确定 NPWT 是否会影响择期开放结肠切除术的伤口并发症。 从 2012 年至 2018 年，通过美国外科医师学会国家手术质量改进计划（ACS-NSQIP）和结肠切除术靶向手术数据库，对接受非紧急计划开放结肠切除术的患者进行了查询。对吻合类型（回肠结肠、结肠结肠、结肠直肠）、年龄、体重指数（BMI）、糖尿病、吸烟、类固醇使用、伤口分类、美国麻醉师学会（ASA）分级、手术时间和关闭的伤口层进行了倾向评分匹配。伤口并发症定义为浅表手术部位感染（SSI）、深部切口 SSI 和裂开。 共确定了 15770 例患者；92 例同时接受 NPWT（0.58%）。非 NPWT 患者以 5:1 的比例匹配，产生 460 次比较。两组患者的伤口并发症无差异（非 NPWT 组为 8.26%，NPWT 组为 6.52%；p=0.574）。此外，仅包括 NPWT 置于闭合皮肤上的患者时，两组的伤口并发症也无差异（非 NPWT 组为 9.11%，NPWT 组为 7.25%；p=0.789）。多变量分析显示，NPWT 与伤口并发症无关（比值比 [OR] 0.79；95%置信区间 [CI]，0.37-1.69）。 NPWT 并不能减少择期开放结肠切除术的伤口并发症。需要进行大型随机研究和更详细的数据来确定在某些患者人群中是否有任何益处。
