Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, 15212, USA.
Lake Erie College of Osteopathic Medicine, Erie, PA, 16509, USA.
Neurosurg Rev. 2024 Nov 15;47(1):847. doi: 10.1007/s10143-024-03083-8.
Surgical site infections (SSIs) following spine surgery are associated with morbidity and resource utilization. Applying prophylactic closed-incisional negative pressure wound therapy (ciNPWT) during posterior instrumented fusion has mixed results in reducing rates of wound complications and SSI. We evaluated the clinical efficacy and potential cost-savings associated with ciNPWT in high-risk patients receiving posterior instrumented spinal fusion.
We retrospectively reviewed patients receiving posterior instrumented spinal fusion for any surgical indication between July 1, 2017 and December 31, 2019, and compared rates of wound dehiscence, SSI, and reoperation for wound complications between standard surgical dressings and ciNPWT. Surgical dressing selection was based on the senior author's assessment of infection risk factors.
A total of 229 patients (n = 85 standard surgical dressings, n = 144 ciNPWT) were included. The ciNPWT group had significantly more risk factors for wound-related complications, including older age (61.8 vs. 58.5 years, p = 0.042), diabetes mellitus (36.8% vs. 23.5%, p = 0.037), more instrumented levels (5.6 vs. 3.9, p < 0.0001), estimated blood loss (1298 vs. 998 mL, p = 0.036), and deformity was the predominant operative indication (29.9% vs. 17.7%, p = 0.040). Prophylactic ciNPWT was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI (8.3% vs. 21.2%, p = 0.005). Number needed to treat with ciNPWT to prevent one SSI was 8 patients. The cost of preventing one SSI was $4,560. Cost-benefit analysis demonstrated a potential mean savings of $21,662 per operative SSI prevented and $270,775 per 100 patients undergoing posterior instrumented fusion with ciNPWT.
Prophylactic ciNPWT use is a cost-effective means of reducing rates of wound dehiscence and SSI following posterior instrumented fusion.
脊柱手术后的手术部位感染（SSI）与发病率和资源利用有关。在接受后路器械融合的患者中应用预防性闭合切口负压伤口治疗（ciNPWT）在降低伤口并发症和 SSI 发生率方面效果不一。我们评估了 ciNPWT 在接受后路器械融合的高风险患者中的临床疗效和潜在成本节约。
我们回顾性分析了 2017 年 7 月 1 日至 2019 年 12 月 31 日期间因任何手术指征接受后路器械融合的患者，比较了标准手术敷料和 ciNPWT 之间的伤口裂开、SSI 和伤口并发症再次手术的发生率。手术敷料的选择基于高级作者对感染危险因素的评估。
共纳入 229 例患者（n=85 例标准手术敷料，n=144 例 ciNPWT）。ciNPWT 组发生与伤口相关并发症的危险因素明显更多，包括年龄较大（61.8 岁 vs. 58.5 岁，p=0.042）、糖尿病（36.8% vs. 23.5%，p=0.037）、器械固定节段更多（5.6 节 vs. 3.9 节，p<0.0001）、估计失血量更多（1298 毫升 vs. 998 毫升，p=0.036）和脊柱畸形为主要手术指征（29.9% vs. 17.7%，p=0.040）。预防性 ciNPWT 与伤口裂开（21.5% vs. 34.1%，p=0.036）和 SSI（8.3% vs. 21.2%，p=0.005）的发生率显著降低相关。使用 ciNPWT 预防 1 例 SSI 的需要治疗人数为 8 人。预防 1 例 SSI 的成本为 4560 美元。成本效益分析表明，每预防 1 例手术部位感染，使用 ciNPWT 可平均节省 21662 美元，每 100 例接受后路器械融合的患者可节省 270775 美元。
预防性 ciNPWT 应用是降低后路器械融合后伤口裂开和 SSI 发生率的一种具有成本效益的方法。
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