Department of Surgery, NYC Health and Hospitals-Elmhurst, Elmhurst, NY, USA.
Am Surg. 2023 Jun;89(6):2313-2320. doi: 10.1177/00031348221091936. Epub 2022 Apr 22.
Wound infection is a common cause of morbidity in colorectal surgery. We speculated that a prophylactic Negative Pressure Wound Treatment (NPWT) is associated with less postoperative wound complications for colorectal cancer patients who undergo a colectomy.
Multivariate analysis was used to investigate the association between NPWT and wound complications for patients with colorectal cancer who underwent a colectomy using data from the National Surgical Quality Improvement Program (NSQIP) database during the 2013 - 2019 period.
We investigated 96 105 patients who underwent colectomy for colorectal cancer during 2013-2019 within the database. Negative Pressure Wound Treatment was utilized for 270 patients following the principal procedure (.3%). Patients who had NPWT had dirtier wounds, less bowel preparation, more extensive surgery (total colectomy vs partial colectomy), higher stoma creation, and more non-elective operations. Multiple factors were associated with postoperative wound complications such as smoking Adjusted Odd Ratio (AOR:1.27, < .01), chronic steroid use (AOR: 1.30, < .01), obesity (AOR: 1.54, < .01), and serum albumin level less than 3.5 g/dL (AOR: 1.29, < .01). Overall, there was no significant decrease in wound complications using NPWT (AOR: .66, = .14). However, a sub-group of patients who underwent emergent/urgent operation had a significant lower risk of wound complications using NPWT (AOR: .3, CI: .09-.99, = .04).
Prophylactic NPWT is associated with a decrease in wound complications of patients who underwent an emergent/urgent colectomy for colorectal cancer. However, we could not find any significant decrease in wound complications for elective colorectal procedures for colorectal cancer. Further clinical trials are needed to confirm these study results.
伤口感染是结直肠手术中常见的发病率原因。我们推测预防性负压伤口治疗（NPWT）与接受结肠切除术的结直肠癌患者术后伤口并发症较少有关。
使用国家手术质量改进计划（NSQIP）数据库在 2013 年至 2019 年期间的数据，对接受结肠切除术的结直肠癌患者的 NPWT 与伤口并发症之间的关系进行多变量分析。
我们调查了数据库中 2013-2019 年期间 96105 例接受结直肠癌结肠切除术的患者。在主要手术后，有 270 例患者使用了 NPWT（0.3%）。接受 NPWT 的患者伤口较脏，肠道准备较少，手术范围更广（全结肠切除术与部分结肠切除术相比），造口术更多，非择期手术更多。多个因素与术后伤口并发症相关，如吸烟调整后的优势比（AOR：1.27，<0.01）、慢性类固醇使用（AOR：1.30，<0.01）、肥胖（AOR：1.54，<0.01）和血清白蛋白水平<3.5 g/dL（AOR：1.29，<0.01）。总体而言，NPWT 并未显著降低伤口并发症的发生率（AOR：0.66，=0.14）。然而，对于接受紧急/紧急手术的患者亚组，NPWT 显著降低了伤口并发症的风险（AOR：0.3，CI：0.09-0.99，=0.04）。
预防性 NPWT 与接受紧急/紧急结肠切除术的结直肠癌患者的伤口并发症减少有关。然而，我们没有发现 NPWT 对择期结直肠手术的结直肠癌患者的伤口并发症有任何显著降低。需要进一步的临床试验来证实这些研究结果。
