E. Buckarma1, M. Mohan1, L. Baddour2, T. Earnest1, H. Schiller1, E. Loomis1 1Mayo Clinic,Department Of Surgery,Rochester, MN, USA 2Mayo Clinic,Department Of Infectious Diseases,Rochester, MN, USA
Objective: Treatment of CIDPI requires a multimodal approach that includes antimicrobials, device explanation and local wound care. Our institution implemented a Practice Management Guideline (PMG) to standardize the care of Cardiovascular Implantable Device Pocket Infections (CIDPI) and engage our Acute Care Surgeons in 2013. Our PMG includes wound culture, complete capsulectomy, pulse lavage and placement of a negative pressure wound therapy device at the time of device extraction. 48 hours later, wounds are irrigated and closed in a delayed primary fashion over drains. Our objective was to compare the outcomes of patients who underwent cardiovascular device extraction before and after the implementation of the PMG for the treatment of CIDPIs.
Methods: An IRB approved retrospective review of 155 patients at our institution from 2012-2015 who underwent cardiovascular device explanation. Evaluated outcomes measured included days from device explant to wound closure, post-operative complications (hematoma, surgical site infection, unplanned return to OR)
Outcomes data was analyzed prior to (Group A) and after (Group B) enactment of the PMGs.
Results: 58 patients (Group A: 42 male, 16 female; mean age 68) were managed prior to PMG implementation and 97 (Group B: 72 male, 25 female; mean age 67) managed after. Mean days from device explanation to wound closure were compared (Group A, 6 ± 3.5 and Group B, 2.6 ± 1.8) and time to closure was reduced by 3 days in Group B (p<0.05). No increase in surgical site infection, unplanned return to OR, hematoma was demonstrated between groups (p<0.05).
Conclusion: The implementation of PMGs is effective in reducing the number of days to pocket wound closure; acute care surgeons are well equipped to participate in this practice and improve patient outcomes.