TY - JOUR
T1 - The use of negative pressure wound therapy to prevent post-operative surgical site infections following pancreaticoduodenectomy
AU - Burkhart, Richard A.
AU - Javed, Ammar A.
AU - Ronnekleiv-Kelly, Sean
AU - Wright, Michael J.
AU - Poruk, Katherine E.
AU - Eckhauser, Frederic
AU - Makary, Martin A.
AU - Cameron, John L.
AU - Wolfgang, Christopher L.
AU - He, Jin
AU - Weiss, Matthew J.
N1 - Publisher Copyright:
© 2017 International Hepato-Pancreato-Biliary Association Inc.
PY - 2017/9
Y1 - 2017/9
N2 - Background Rates of superficial surgical site infection (SSI) following pancreaticoduodenectomy remain high. Following resection for cancer, complications such as SSI impact adjuvant therapy delivery and portend worse survival. An incisional negative pressure dressing (iVAC) has been demonstrated to reduce SSI in other high-risk cohorts. Methods Following a comprehensive effort to identify patients at high risk for SSI, the practice patterns at a single academic center shifted and iVAC use increased. SSI rates were tracked in a prospectively maintained database and are reported. Results 394 patients underwent pancreaticoduodenectomy over 21 months. 120 patients (30.5%) had an iVAC applied. The overall rate of SSI was 19.8%. On multivariate analysis, increased risk for SSI was associated with neoadjuvant therapy, preoperative biliary interventions and prior abdominal surgery. iVAC use decreased the rate of SSI (OR 0.45, p = 0.015). In the highest-risk patients, SSI rate declined from 50% in patients without an iVAC to 19.1% with iVAC use (p = 0.015). Conclusion The use of an iVAC following pancreaticoduodenectomy is associated with decreased SSI rates. This is particularly true for patients at highest risk as defined by a previously established risk scoring system in patients undergoing open pancreaticoduodenectomy.
AB - Background Rates of superficial surgical site infection (SSI) following pancreaticoduodenectomy remain high. Following resection for cancer, complications such as SSI impact adjuvant therapy delivery and portend worse survival. An incisional negative pressure dressing (iVAC) has been demonstrated to reduce SSI in other high-risk cohorts. Methods Following a comprehensive effort to identify patients at high risk for SSI, the practice patterns at a single academic center shifted and iVAC use increased. SSI rates were tracked in a prospectively maintained database and are reported. Results 394 patients underwent pancreaticoduodenectomy over 21 months. 120 patients (30.5%) had an iVAC applied. The overall rate of SSI was 19.8%. On multivariate analysis, increased risk for SSI was associated with neoadjuvant therapy, preoperative biliary interventions and prior abdominal surgery. iVAC use decreased the rate of SSI (OR 0.45, p = 0.015). In the highest-risk patients, SSI rate declined from 50% in patients without an iVAC to 19.1% with iVAC use (p = 0.015). Conclusion The use of an iVAC following pancreaticoduodenectomy is associated with decreased SSI rates. This is particularly true for patients at highest risk as defined by a previously established risk scoring system in patients undergoing open pancreaticoduodenectomy.
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U2 - 10.1016/j.hpb.2017.05.004
DO - 10.1016/j.hpb.2017.05.004
M3 - Article
C2 - 28602643
AN - SCOPUS:85020252861
SN - 1365-182X
VL - 19
SP - 825
EP - 831
JO - HPB
JF - HPB
IS - 9
ER -