Surgical site infection requiring hospitalisation unchanged with a prophylactic incisional negative pressure wound therapy guideline: an observational cohort study

Abstract

Background: Despite numerous published prospective studies, evidence to support use of prophylactic incisional negative pressure wound therapy, for obstetric and gynaecologic surgery, is conflicting.

Aim:  To evaluate if wound-related presentations to hospital were reduced following introduction of a guideline promoting selective use of prophylactic incisional negative pressure wound therapy.

Methods: This was an observational cohort study. Electronic medical records were reviewed for all hospital presentations, within 30 days of primary surgery performed by laparotomy, where the responsible clinician was an obstetrician or gynaecologist. Rates of wound complications and costs associated with admission were compared pre- and post-guideline.

Results: Among all those who underwent caesarean birth (n = 2788) or gynaecologic laparotomy (n= 263), 5% presented to hospital with SSI, and 1% with non-infected wound problems. No significant reductions in SSI hospital presentations, length of stay, or readmission costs were observed post-implementation. Likewise, no improvements were observed for non-infected wound problems or a composite of SSI and non-infected wound problems.

Conclusions: This study does not support the selective approach used to direct prophylactic incisional negative pressure wound therapy. Further studies are required to better individualise risk assessment, and to determine if negative pressure wound therapy can reduce serious morbidity of SSI. When robust evidence is lacking, local outcomes should be evaluated systematically and reviewed before new treatments become standard care.