Ariel Santos, MD, MPH, FCCM
MD, MPH, FACS, FRCSC, FCCM
Texas Tech University Health Science Center
Lubbock, Texas
Disclosure information not submitted.
Avery Endsley, BS
Medical Student
Texas Tech University Health Sciences Center
Lubbock, Texas, United States
Disclosure information not submitted.
Kripa Shrestha, MBBS, MS, MPH
Research Associate
Texas Tech University Health Sciences Center Department of Surgery, United States
Disclosure information not submitted.
Alexis Cruz, MD
Medical Student
Texas Tech University Health Sciences Center
Lubbock, Texas, United States
Disclosure information not submitted.
Anastazia Gilman, BS
Medical Student
Texas Tech University Health Sciences Center
Lubbock, Texas, United States
Disclosure information not submitted.
Jonathan Huynh, MD
Surgery Resident
TTUHSC Department of Surgery
Lubbock, Texas, United States
Disclosure information not submitted.
Justin Vaughan, MD
Assistant Professor
Texas Tech University Health Sciences Center
Lubbock, Texas, United States
Disclosure information not submitted.
Title: Negative Pressure Wound Therapy in Exploratory Laparotomies with Coexisting Ostomy
Introduction: Surgical site infections (SSI) are one of the most common healthcare-associated infection. It is unknown if patients with ostomies, especially colostomies are at greater risk for wound infections following exploratory laparotomies (EL). Previous studies have shown that the use of negative pressure wound therapy (NPWT) decreases the overall rate of SSI, rate of wound dehiscence and length of hospital stay. The aim of this study is to determine the impact of NPWT on patient with coexisting ostomies undergoing EL.
Methods: A retrospective review was conducted on patient undergoing exploratory EL from March 2017 to March 2019. A comparison of baseline characteristics and clinical outcome were compared between those receiving NPWT and those receiving standard post-operative wound care (Kerlix dressing). A sub analysis of patient with ostomies was performed.
Results: A total 286 patient who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received Kerlix dressing. The NPWT group had higher percentage of patient with ostomy (37.3% vs 20.4, p=0.01), of which colostomies were (25.5 % vs 12.3%, p= 0.01) and ileostomies were (11.8% vs 8.1, p=0.01). The NWPT group was found to have BMI >25 (84.3% vs 66.4, p=0.02).
No significant difference in overall rate of SSI (7.8% vs 5.5%, p= 0.76); wound dehiscence (7.8% vs 2.1 %, p=0.57) and mean length of hospital stay (11.6 vs 11.3, p=0.62) were observed. A significant difference in seroma formation (9.8 vs 2.1, p=0.01) and mean length of ICU stay (3.7 vs 7.2, p=0.004) were observed. The overall mortality was lower in NWPT group (3.9% vs 13.6, p=0.05). A sub analysis of patient with ostomies was found to have high SSI on NWPT group (10% vs 8.5%, p=0.02).
Conclusions: The use of negative pressure wound dressing like Prevena was not associated with reduction of SSI; however, was associated with decrease in seroma formation and mean length of ICU stay. The overall mortality was significantly lower in NWPT group. Large studies are needed to ascertain significant benefit in patient with ostomies.