Department of Neurosurgery, Georgetown University Medical Center, Washington, District of Columbia, USA.
Georgetown University School of Medicine, Washington, District of Columbia, USA.
Neurosurgery. 2021 Apr 15;88(5):E445-E451. doi: 10.1093/neuros/nyab040.
Use of a closed-incisional negative pressure therapy (ci-NPT) dressing is an emerging strategy to reduce surgical site infections (SSIs) in spine surgery that lacks robust data.
To determine the impact of a ci-NPT, as compared with a standard dressing, on the development of SSIs after spine surgery.
This was a prospective observational study over a 2-yr period. Indications for surgery included degenerative disease, deformity, malignancy, and trauma. Exclusion criteria included anterior and lateral approaches to the spine, intraoperative durotomy, or use of minimally invasive techniques. SSIs up to 60 d following surgery were recorded.
A total of 274 patients were included. SSI rate was significantly lower with ci-NPT dressing (n = 118) as compared with the standard dressing (n = 156) (3.4 vs 10.9%, P = .02). There was no statistical difference in infection rate for decompression alone procedures (4.2 vs 9.1%, P = .63), but there was a statistically significant reduction with the use of a negative-pressure dressing in cases that required instrumentation (3.2 vs 11.4%, P = .03). Patients at higher risk (instrumentation, deformity, and malignancy) had less SSIs with the use of ci-NPT, although this did not reach statistical significance. There were no complications in either group.
SSI rates were significantly reduced with a ci-NPT dressing vs a standard dressing in patients who underwent spinal surgery. The higher cost of a ci-NPT dressing might be justified with instrumented cases, as well as with certain high-risk patient populations undergoing spine surgery, given the serious consequences of an infection.
使用密闭切口负压治疗(ci-NPT)敷料是一种减少脊柱手术部位感染(SSI)的新兴策略,但缺乏强有力的数据支持。
比较 ci-NPT 与标准敷料对脊柱手术后 SSI 发生的影响。
这是一项为期 2 年的前瞻性观察性研究。手术适应证包括退行性疾病、畸形、恶性肿瘤和创伤。排除标准包括脊柱前路和侧路入路、术中硬脊膜切开术或微创技术的使用。记录术后 60d 内的 SSI。
共纳入 274 例患者。与标准敷料组(n=156)相比,ci-NPT 敷料组的 SSI 发生率显著降低(n=118)(3.4% vs. 10.9%,P=0.02)。单纯减压手术的感染率无统计学差异(4.2% vs. 9.1%,P=0.63),但需要器械固定的病例使用负压敷料可显著降低感染率(3.2% vs. 11.4%,P=0.03)。在使用 ci-NPT 的情况下,高风险患者(器械固定、畸形和恶性肿瘤)的 SSI 发生率较低,但未达到统计学意义。两组均无并发症。
与标准敷料相比,ci-NPT 敷料可显著降低脊柱手术患者的 SSI 发生率。对于接受脊柱手术的器械固定病例以及某些高危人群,ci-NPT 敷料的高成本可能是合理的,因为感染会带来严重的后果。