Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: A single institutional experience

Owoicho Adogwa, Parastou Fatemi, Edgar Perez, Jessica Moreno, Gustavo Chagoya Gazcon, Ziya L. Gokaslan, Joseph Cheng, Oren Gottfried, Carlos A. Bagley

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background context Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.

Study design Retrospective study.

Patient sample One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.

Outcome measures Postoperative incidence of wound infection and dehiscence.

Methods All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.

Results One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).

Conclusions Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.

Original languageEnglish (US)
Pages (from-to)2911-2917
Number of pages7
JournalSpine Journal
Volume14
Issue number12
DOIs
StatePublished - Jan 1 2014

Fingerprint

Negative-Pressure Wound Therapy
Surgical Wound Infection
Spinal Fusion
Incidence
Wounds and Injuries
Pressure
Spine
Patient Readmission
Equipment and Supplies
Granulation Tissue
Wound Infection
Intravenous Administration
Therapeutics
Rehabilitation
Retrospective Studies
Cell Proliferation
Outcome Assessment (Health Care)
Anti-Bacterial Agents

Keywords

  • Deformity
  • Negative pressure wound therapy
  • Spine outcomes
  • Surgical site infections
  • Wound dehiscence
  • Wound infection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion : A single institutional experience. / Adogwa, Owoicho; Fatemi, Parastou; Perez, Edgar; Moreno, Jessica; Gazcon, Gustavo Chagoya; Gokaslan, Ziya L.; Cheng, Joseph; Gottfried, Oren; Bagley, Carlos A.

In: Spine Journal, Vol. 14, No. 12, 01.01.2014, p. 2911-2917.

Research output: Contribution to journalArticle

Adogwa, Owoicho ; Fatemi, Parastou ; Perez, Edgar ; Moreno, Jessica ; Gazcon, Gustavo Chagoya ; Gokaslan, Ziya L. ; Cheng, Joseph ; Gottfried, Oren ; Bagley, Carlos A. / Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion : A single institutional experience. In: Spine Journal. 2014 ; Vol. 14, No. 12. pp. 2911-2917.
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title = "Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: A single institutional experience",
abstract = "Background context Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.Study design Retrospective study.Patient sample One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.Outcome measures Postoperative incidence of wound infection and dehiscence.Methods All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.Results One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50{\%} decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38{\%} vs. 12.28{\%}, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63{\%} vs. 14.91{\%}, p=.04).Conclusions Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.",
keywords = "Deformity, Negative pressure wound therapy, Spine outcomes, Surgical site infections, Wound dehiscence, Wound infection",
author = "Owoicho Adogwa and Parastou Fatemi and Edgar Perez and Jessica Moreno and Gazcon, {Gustavo Chagoya} and Gokaslan, {Ziya L.} and Joseph Cheng and Oren Gottfried and Bagley, {Carlos A.}",
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T1 - Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion

T2 - A single institutional experience

AU - Adogwa, Owoicho

AU - Fatemi, Parastou

AU - Perez, Edgar

AU - Moreno, Jessica

AU - Gazcon, Gustavo Chagoya

AU - Gokaslan, Ziya L.

AU - Cheng, Joseph

AU - Gottfried, Oren

AU - Bagley, Carlos A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background context Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.Study design Retrospective study.Patient sample One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.Outcome measures Postoperative incidence of wound infection and dehiscence.Methods All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.Results One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).Conclusions Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.

AB - Background context Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.Study design Retrospective study.Patient sample One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.Outcome measures Postoperative incidence of wound infection and dehiscence.Methods All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.Results One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).Conclusions Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.

KW - Deformity

KW - Negative pressure wound therapy

KW - Spine outcomes

KW - Surgical site infections

KW - Wound dehiscence

KW - Wound infection

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