Presentations

Abstract

Introduction:

A surgical site infection (SSI) is an infection following an operation at an incision site or adjacent to the surgical incision. SSIs remain a common hospital-acquired condition and contributes to substantial patient morbidity and mortality as well as financial burden for the healthcare system. The prevalence of SSI is particularly high in trauma laparotomy wounds, and although there is good evidence for the use of incisional negative pressure wound therapy (iNPWT) in the prevention of SSI in laparotomy wounds, there is limited data on the use of iNPWT in management of wounds of laparotomies performed due to trauma. This study aims to expand the size of the sample utilized by the only previous study to investigate the utility of iNPWT in the care of trauma laparotomy wounds. We hypothesize that rates of SSI and wound dehiscence will be decreased in trauma laparotomy wounds with use of iNPWT such as the Prevena Incision Management System.

Methods:

A retrospective chart analysis was performed on trauma patients who underwent trauma laparotomies at Sentara Norfolk General Hospital, the level 1 trauma and tertiary referral center for the Hampton Roads area of Virginia. The inclusion criteria included any trauma patient that received an exploratory laparotomy on admission admitted between January 2015 and March 2022 between the ages of 18 and 89. The exclusion criteria included any mortality within 7 days of admission, patients with open abdomens on index procedure or requiring a repeat exploratory laparotomy within 30 days post operatively. Patient demographics, comorbidities, and closure type were documented. A chi-square test of independence was performed to examine the relation between closure type and development of superficial SSI and wound dehiscence. A p-value below 0.05 was deemed statistically significant.

Results:

247 patients were analyzed that met our inclusion and exclusion criteria. 135 patients were closed with iNPWT, 112 patients were closed with staples alone. The proportion of patients who developed superficial SSI was 9.8% for the staples group and 4.4% for the iNPWT group, X2 (1, N = 247) = 2.7, p = .097. The proportion of patients who developed wound dehiscence was 17.8% for the staples group and 6.7% for the iNPWT group, X2 (1, N = 247) = 7.4, p = .006. A subset analysis was done on patients that had a gastric, small bowel, or colonic injury with perforation or injury requiring resection. Within this subset, the proportion of patients who developed superficial SSI was 17.0% for the staples group and 5.3% for the iNPWT group, X2 (1, N = 141) = 5.1, p = .023.

Conclusion:

Our retrospective study showed that there was no statistical difference in the development of superficial SSI between the iNPWT group and staples group, but there was a difference seen in the subgroup which only included gastrointestinal tract perforations or resections. There was a statistical difference in the development of wound dehiscence between the iNPWT group and staples group.