Effect of Negative Pressure Wound Therapy on Wound Complications Post-Pancreatectomy
Surgical site infection (SSI) and incisional hernia are common complications after major pancreatectomy. We investigated the effects of negative pressure wound therapy (NPWT) on short-and long-term wound outcomes in patients undergoing pancreatectomy. A randomized controlled trial comparing the effe...
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| Veröffentlicht in: | The American surgeon 2019-01, Vol.85 (1), p.1-7 |
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| creator | Kuncewitch, Michael P. Blackham, Aaron U. Clark, Clancy J. Dodson, Rebecca M. Russell, Gregory B. Levine, Edward A. Shen, Perry |
| description | Surgical site infection (SSI) and incisional hernia are common complications after major pancreatectomy. We investigated the effects of negative pressure wound therapy (NPWT) on short-and long-term wound outcomes in patients undergoing pancreatectomy. A randomized controlled trial comparing the effect of NPWT with standard surgical dressing (SSD) on wounds was performed in 265 patients undergoing open gastrointestinal resections from 2012 to 2016. We performed a subset analysis of 73 patients who underwent pancreatectomy. Wound complications in the first 30 days and incisional hernia rates were assessed. There were 33 (45%) female patients in the study and the average BMI was 27.6. The pancreaticoduodectomy rate was 68 per cent, whereas 27 per cent of patients underwent distal or subtotal pancreatectomy, and 4 per cent total pancreatectomy. Incisional hernia rates were 32 per cent and 14 per cent between the SSD and NPWT groups, respectively (P = 0.067). In the SSD (n = 37) and NPWT (n = 36) cohorts, the superficial SSI, deep SSI, seroma, and dehiscence rates were 16 per cent and 14 per cent (P > 0.99), 5 per cent and 8 per cent (P = 0.67), 16 per cent and 11 per cent (P = 0.74), and 5 per cent and 3 per cent (P ≥ 0.99), respectively. After adjusting for pancreatic fistula and delayed gastric emptying, no statistically significant differences in the primary outcomes were observed. These findings were true irrespective of the type of resection performed. Short- and long-term wound complications were not improved with NPWT. We observed a trend toward decreased incisional hernia rates in patients treated with NPWT. Owing to the multifactorial nature of wound complications, it is yet to be determined which cohorts of pancreatectomy patients will benefit from NPWT. |
| doi_str_mv | 10.1177/000313481908500102 |
| format | Article |
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We investigated the effects of negative pressure wound therapy (NPWT) on short-and long-term wound outcomes in patients undergoing pancreatectomy. A randomized controlled trial comparing the effect of NPWT with standard surgical dressing (SSD) on wounds was performed in 265 patients undergoing open gastrointestinal resections from 2012 to 2016. We performed a subset analysis of 73 patients who underwent pancreatectomy. Wound complications in the first 30 days and incisional hernia rates were assessed. There were 33 (45%) female patients in the study and the average BMI was 27.6. The pancreaticoduodectomy rate was 68 per cent, whereas 27 per cent of patients underwent distal or subtotal pancreatectomy, and 4 per cent total pancreatectomy. Incisional hernia rates were 32 per cent and 14 per cent between the SSD and NPWT groups, respectively (P = 0.067). In the SSD (n = 37) and NPWT (n = 36) cohorts, the superficial SSI, deep SSI, seroma, and dehiscence rates were 16 per cent and 14 per cent (P > 0.99), 5 per cent and 8 per cent (P = 0.67), 16 per cent and 11 per cent (P = 0.74), and 5 per cent and 3 per cent (P ≥ 0.99), respectively. After adjusting for pancreatic fistula and delayed gastric emptying, no statistically significant differences in the primary outcomes were observed. These findings were true irrespective of the type of resection performed. Short- and long-term wound complications were not improved with NPWT. We observed a trend toward decreased incisional hernia rates in patients treated with NPWT. Owing to the multifactorial nature of wound complications, it is yet to be determined which cohorts of pancreatectomy patients will benefit from NPWT.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/000313481908500102</identifier><identifier>PMID: 30760337</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Abdomen ; Adult ; Aged ; Aged, 80 and over ; Angiogenesis ; Body mass ; Cancer therapies ; Clinical trials ; Complications ; Dehiscence ; Female ; Fistula ; Fistulae ; Gastric emptying ; Hernia ; Hospitals ; Humans ; Incisional Hernia - epidemiology ; Infections ; Infectious diseases ; Laparoscopy ; Male ; Medical dressings ; Middle Aged ; Negative-Pressure Wound Therapy ; Pancreas ; Pancreatectomy ; Pancreatectomy - adverse effects ; Pancreatic Diseases - surgery ; Pancreaticoduodenectomy - adverse effects ; Patients ; Pressure ; Pressure effects ; Prevention ; Quality of life ; Seroma - epidemiology ; Statistical analysis ; Surgery ; Surgical dressings ; Surgical site infections ; Surgical Wound Dehiscence - epidemiology ; Surgical Wound Infection - epidemiology ; Therapy ; Wound healing ; Wounds</subject><ispartof>The American surgeon, 2019-01, Vol.85 (1), p.1-7</ispartof><rights>2019 Southeastern Surgical Congress</rights><rights>Copyright Southeastern Surgical Congress Jan 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-42ce3ad03b6a9477569e0ef22c37f303d7aac29b774f49b061756b3ce3a52ea13</citedby><cites>FETCH-LOGICAL-c470t-42ce3ad03b6a9477569e0ef22c37f303d7aac29b774f49b061756b3ce3a52ea13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/000313481908500102$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/000313481908500102$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>230,314,776,780,881,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30760337$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kuncewitch, Michael P.</creatorcontrib><creatorcontrib>Blackham, Aaron U.</creatorcontrib><creatorcontrib>Clark, Clancy J.</creatorcontrib><creatorcontrib>Dodson, Rebecca M.</creatorcontrib><creatorcontrib>Russell, Gregory B.</creatorcontrib><creatorcontrib>Levine, Edward A.</creatorcontrib><creatorcontrib>Shen, Perry</creatorcontrib><title>Effect of Negative Pressure Wound Therapy on Wound Complications Post-Pancreatectomy</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Surgical site infection (SSI) and incisional hernia are common complications after major pancreatectomy. We investigated the effects of negative pressure wound therapy (NPWT) on short-and long-term wound outcomes in patients undergoing pancreatectomy. A randomized controlled trial comparing the effect of NPWT with standard surgical dressing (SSD) on wounds was performed in 265 patients undergoing open gastrointestinal resections from 2012 to 2016. We performed a subset analysis of 73 patients who underwent pancreatectomy. Wound complications in the first 30 days and incisional hernia rates were assessed. There were 33 (45%) female patients in the study and the average BMI was 27.6. The pancreaticoduodectomy rate was 68 per cent, whereas 27 per cent of patients underwent distal or subtotal pancreatectomy, and 4 per cent total pancreatectomy. Incisional hernia rates were 32 per cent and 14 per cent between the SSD and NPWT groups, respectively (P = 0.067). In the SSD (n = 37) and NPWT (n = 36) cohorts, the superficial SSI, deep SSI, seroma, and dehiscence rates were 16 per cent and 14 per cent (P > 0.99), 5 per cent and 8 per cent (P = 0.67), 16 per cent and 11 per cent (P = 0.74), and 5 per cent and 3 per cent (P ≥ 0.99), respectively. After adjusting for pancreatic fistula and delayed gastric emptying, no statistically significant differences in the primary outcomes were observed. These findings were true irrespective of the type of resection performed. Short- and long-term wound complications were not improved with NPWT. We observed a trend toward decreased incisional hernia rates in patients treated with NPWT. Owing to the multifactorial nature of wound complications, it is yet to be determined which cohorts of pancreatectomy patients will benefit from NPWT.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiogenesis</subject><subject>Body mass</subject><subject>Cancer therapies</subject><subject>Clinical trials</subject><subject>Complications</subject><subject>Dehiscence</subject><subject>Female</subject><subject>Fistula</subject><subject>Fistulae</subject><subject>Gastric emptying</subject><subject>Hernia</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incisional Hernia - epidemiology</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Laparoscopy</subject><subject>Male</subject><subject>Medical dressings</subject><subject>Middle Aged</subject><subject>Negative-Pressure Wound Therapy</subject><subject>Pancreas</subject><subject>Pancreatectomy</subject><subject>Pancreatectomy - adverse effects</subject><subject>Pancreatic Diseases - surgery</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Patients</subject><subject>Pressure</subject><subject>Pressure effects</subject><subject>Prevention</subject><subject>Quality of life</subject><subject>Seroma - epidemiology</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surgical dressings</subject><subject>Surgical site infections</subject><subject>Surgical Wound Dehiscence - epidemiology</subject><subject>Surgical Wound Infection - epidemiology</subject><subject>Therapy</subject><subject>Wound healing</subject><subject>Wounds</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kVtLwzAYhoMobk7_gBdS8Mabak5t2htBxjzA0F1MvAxp9nXraJuZtIP9e1M25wm8Ckme9_0OL0LnBF8TIsQNxpgRxhOS4iTCmGB6gPokiqIwTSg7RP0OCDuih06cW_orjyNyjHoMixgzJvpoOspz0E1g8uAZ5qop1hBMLDjXWgjeTFvPgukCrFptAlPvHoamWpWF9rCpXTAxrgknqtYWVOOtTLU5RUe5Kh2c7c4Ber0fTYeP4fjl4Wl4Nw41F7gJOdXA1AyzLFYpFyKKU8CQU6qZyBlmM6GUpmkmBM95muGYeCRjnSiioAgboNut76rNKphpqBurSrmyRaXsRhpVyJ8_dbGQc7OWseB-K4k3uNoZWPPegmtkVTgNZalqMK2TlCR-nYxz6tHLX-jStLb243UU7yIQXUd0S2lrnLOQ75shWHahyb-hedHF9zH2ks-UPHCzBZyaw1fdfyw_AMuqn2Y</recordid><startdate>201901</startdate><enddate>201901</enddate><creator>Kuncewitch, Michael P.</creator><creator>Blackham, Aaron U.</creator><creator>Clark, Clancy J.</creator><creator>Dodson, Rebecca M.</creator><creator>Russell, Gregory B.</creator><creator>Levine, Edward A.</creator><creator>Shen, Perry</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>201901</creationdate><title>Effect of Negative Pressure Wound Therapy on Wound Complications Post-Pancreatectomy</title><author>Kuncewitch, Michael P. ; Blackham, Aaron U. ; Clark, Clancy J. ; Dodson, Rebecca M. ; Russell, Gregory B. ; Levine, Edward A. ; Shen, Perry</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-42ce3ad03b6a9477569e0ef22c37f303d7aac29b774f49b061756b3ce3a52ea13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Abdomen</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angiogenesis</topic><topic>Body mass</topic><topic>Cancer therapies</topic><topic>Clinical trials</topic><topic>Complications</topic><topic>Dehiscence</topic><topic>Female</topic><topic>Fistula</topic><topic>Fistulae</topic><topic>Gastric emptying</topic><topic>Hernia</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incisional Hernia - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kuncewitch, Michael P.</au><au>Blackham, Aaron U.</au><au>Clark, Clancy J.</au><au>Dodson, Rebecca M.</au><au>Russell, Gregory B.</au><au>Levine, Edward A.</au><au>Shen, Perry</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Negative Pressure Wound Therapy on Wound Complications Post-Pancreatectomy</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2019-01</date><risdate>2019</risdate><volume>85</volume><issue>1</issue><spage>1</spage><epage>7</epage><pages>1-7</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Surgical site infection (SSI) and incisional hernia are common complications after major pancreatectomy. We investigated the effects of negative pressure wound therapy (NPWT) on short-and long-term wound outcomes in patients undergoing pancreatectomy. A randomized controlled trial comparing the effect of NPWT with standard surgical dressing (SSD) on wounds was performed in 265 patients undergoing open gastrointestinal resections from 2012 to 2016. We performed a subset analysis of 73 patients who underwent pancreatectomy. Wound complications in the first 30 days and incisional hernia rates were assessed. There were 33 (45%) female patients in the study and the average BMI was 27.6. The pancreaticoduodectomy rate was 68 per cent, whereas 27 per cent of patients underwent distal or subtotal pancreatectomy, and 4 per cent total pancreatectomy. Incisional hernia rates were 32 per cent and 14 per cent between the SSD and NPWT groups, respectively (P = 0.067). In the SSD (n = 37) and NPWT (n = 36) cohorts, the superficial SSI, deep SSI, seroma, and dehiscence rates were 16 per cent and 14 per cent (P > 0.99), 5 per cent and 8 per cent (P = 0.67), 16 per cent and 11 per cent (P = 0.74), and 5 per cent and 3 per cent (P ≥ 0.99), respectively. After adjusting for pancreatic fistula and delayed gastric emptying, no statistically significant differences in the primary outcomes were observed. These findings were true irrespective of the type of resection performed. Short- and long-term wound complications were not improved with NPWT. We observed a trend toward decreased incisional hernia rates in patients treated with NPWT. Owing to the multifactorial nature of wound complications, it is yet to be determined which cohorts of pancreatectomy patients will benefit from NPWT.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>30760337</pmid><doi>10.1177/000313481908500102</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdomen Adult Aged Aged, 80 and over Angiogenesis Body mass Cancer therapies Clinical trials Complications Dehiscence Female Fistula Fistulae Gastric emptying Hernia Hospitals Humans Incisional Hernia - epidemiology Infections Infectious diseases Laparoscopy Male Medical dressings Middle Aged Negative-Pressure Wound Therapy Pancreas Pancreatectomy Pancreatectomy - adverse effects Pancreatic Diseases - surgery Pancreaticoduodenectomy - adverse effects Patients Pressure Pressure effects Prevention Quality of life Seroma - epidemiology Statistical analysis Surgery Surgical dressings Surgical site infections Surgical Wound Dehiscence - epidemiology Surgical Wound Infection - epidemiology Therapy Wound healing Wounds |
| title | Effect of Negative Pressure Wound Therapy on Wound Complications Post-Pancreatectomy |
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