C. J. Lee1, G. Sharma1, C. Blanco1, A. Bhargava1, S. Patil1, F. Weng2, S. Geffner1,2, H. Sun1,2 1Saint Barnabas Medical Center,Department Of Surgery,Livingston, NJ, USA 2Saint Barnabas Medical Center,Renal And Pancreas Transplant Division,Livingston, NJ, USA
Introduction: Despite being the most commonly transplanted organ, renal transplantation still has several complications, one of the most frequent being surgical site infections (SSI). This study examines the effectiveness of closed incision negative pressure wound therapy (NPWT) and antimicrobial foam dressings in preventing SSI in kidney transplant patients.
Methods: A retrospective chart review was performed on 78 patients who received a kidney transplantation from June 2015 to August 2015. The recipients were divided into high risk (Body mass index over 30, on hemodialysis over 5 years, or pre-transplant diabetes mellitus) and low risk. High risk patients were dressed with closed incision NPWT, and low risk patients with antimicrobial foam. All patients received antibiotics within 30 minutes of the incision. The incision was closed in multiple layers and skin was closed with surgical staplers. Both dressings were applied intraoperatively and removed 5 to 7 days postoperatively. Wounds were evaluated until 30 days postoperatively. The primary end point of the study was SSI as defined according to the definition of the Centers for Disease Control and Prevention. Univariate analysis was performed by using Chi-square test for categorical and continuous variables. A P value of .05 or less was considered statistically significant. SPSS 20.0 statistical package was used to perform data evaluation.
Results: NPWT was used in 39 patients, out of which 17 patients received a living donor kidney transplant (LDKT) and 22 patients received a deceased donor kidney transplant (DDKT). Antimicrobial foam dressing was applied in 39 patients, out of which 21 patients received a LDKT and 18 patients received a DDKT. Eight patients in the antimicrobial foam group underwent re-operation and none of them were for wound infection. Six patients in the NPWT group underwent re-operation, and 2 out of 6 patients were because of wound infection. SSI in high-risk patients at the same institution in 2014 was 22%, which was reduced to 12.8% in patients from June to August 2015, after implementation of the NPWT dressing. The SSI in the low-risk patients in 2014 was 6%, which was reduced to 0% after implementation of the antimicrobial foam dressing. On Univariate analysis, BMI, diabetes and peri-operative transfusion were the significantly different factors between the two groups. On multivariate analysis, there were no independent factors associated with wound infection. (Table 1)
Conclusion: Based on our initial experience, closed incision NPWT and antimicrobial foam dressings, in addition to standard perioperative measures, have shown encouraging results in reducing surgical site infections for high- and low- risk renal transplant recipients.
