Closed incision negative pressure wound therapy following pancreaticoduodenectomy for prevention of surgical site infections in high-risk patients.

Autor:	Greene B; From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman)., Lagrotteria A; From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman)., Tsang ME; From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman)., Jayaraman S; From the Division of General Surgery, Section of Hepatobiliary-Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, Mo. (Greene); Temerty Faculty of Medicine (Lagrotteria), and Division of General Surgery, Department of Surgery, Temerty Faculty of Medicine, University of Toronto (Tsang, Jayaraman); Division of General Surgery, St. Joseph's Health Centre (Tsang, Jayaraman), and Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ont. (Jayaraman) shiva.jayaraman@unityhealth.to.
Jazyk:	angličtina
Zdroj:	Canadian journal of surgery. Journal canadien de chirurgie [Can J Surg] 2023 Oct 24; Vol. 66 (5), pp. E507-E512. Date of Electronic Publication: 2023 Oct 24 (Print Publication: 2023).
DOI:	10.1503/cjs.000723
Abstrakt:	Background: Surgical site infection (SSI) is one of the most common sources of morbidity after pancreaticoduodenectomy. Surgical site infections are associated with readmissions, prolonged length of stay, delayed initiation of adjuvant chemotherapy and negative effects on quality of life. Incisional vacuum-assisted closure (iVAC) devices applied on closed incisions may reduce SSI rates. The objective of this retrospective review is to evaluate the impact of iVAC on SSI rate after pancreaticoduodenectomy. Methods: A cohort of patients undergoing pancreaticoduodenectomy at a single institution who had at least 1 risk factor for SSI and who received an iVAC were compared with a historical cohort of high-risk patients who received conventional dressings after pancreaticoduodenectomy. The primary outcome was incidence of SSI within 30 days, abstracted from chart review. Secondary outcomes were 30-day readmission, 90-day mortality, rate of postoperative pancreatic fistula and rate of delayed gastric emptying. Results: In total, 175 patients were included, of whom 61 received an iVAC. The incidence of SSI was 13% (8 of 61 patients) and 16% (18 of 114 patients) in the iVAC and conventional dressing groups, respectively (odds ratio 0.81, 95% confidence interval 0.33-1.98). Preoperative biliary drainage was the most frequent SSI risk factor. Binary logistic regression using SSI as the outcome demonstrated no significant association with iVAC use when adjusted for SSI risk factors. There were no differences in rates of postoperative pancreatic fistula, delayed gastric emptying or 90-day mortality. Conclusion: This report describes the outcomes of the integration of iVAC devices into routine clinical practice at a high-volume institution. Application of this device after pancreaticoduodenectomy for patients at elevated risk of SSI was not associated with a reduction in the rate of SSIs. Competing Interests: Competing interests: None declared. (© 2023 CMA Impact Inc. or its licensors.)
Databáze:	MEDLINE
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