M. R. Phillips2, S. L. English1, E. Teeple1, A. E. Martin1, K. Reichard1, C. D. Vinocur1, L. Berman1 1Nemours/Alfred I DuPont Hospital for Children,Sidney Kimmel School Of Medicine At Thomas Jefferson University,Wilmington, DE, USA 2University Of North Carolina At Chapel Hill,Surgery,Chapel Hill, NC, USA
Introduction: Surgical site infection (SSI) rates are an important quality metric in surgery. Adult studies have demonstrated a decrease in rate of SSI with the use of negative pressure incisional wound vac device (NPIWV) dressings. No studies have examined the effect of NPIWV dressings on SSI rates in pediatric patients.
Methods: We performed a retrospective review of patients who underwent surgery using NPIWV at our institution between February 2016 and February 2018. NPIWV dressings were applied by approximating the skin edges with buried, absorbable sutures, protecting the skin with adhesive barrier, covering the wound with black sponge, and applying negative pressure for up to 4 days. We identified a group of patients with the same CPT codes from our National Surgical Quality Improvement Program-Pediatric (NSQIP-P) data between January 2014 and January 2016, in order to compare SSI rates in the NPIWV population to historical controls. The cohorts were compared using either a Mann-Whitney test or chi-square analysis (p<0.05).
Results: Thirty-five patients underwent surgery using NPIWV for wound closure. Sixty-four patients with similar CPT codes were identified from our institutional NSQIP-P data who did not have NPIWV dressings (Table 1). The groups were comparable. In the NPIWV group there was 1 SSI in 35 cases (2.9%), and there were 7 SSIs in the 64 historical control patients (10.9%). The difference in SSI rates did not reach significance (p=0.25, OR: 4.18 CI [0.49-35.43]). There were no complications associated with the use of NPIWV dressings
Conclusion: NPIWV dressings can be used safely for the management of contaminated wounds in pediatric patients undergoing surgery, including neonatal patients. Our study shows a trend toward decreased SSI rates with NPIWV. However, our sample size was likely too small to reach statistical significance. These findings from a small retrospective study need to be confirmed in a larger, prospective trial.
