Considering Closed Incision Negative Pressure Therapy for Obese Patients with Gynecologic Malignancies [31E

Abstract

INTRODUCTION: In patients with major comorbidities undergoing complex gynecologic surgery, incision management is critical. This retrospective review examined factors associated with incisional complications in patients with multiple comorbidities who underwent laparotomy by the Division of Gynecologic Oncology at our institution. METHODS: A retrospective chart review was performed to identify patients who underwent laparotomy for either complex benign gynecologic procedures or gynecologic malignancies from 2013 to July 2016. Descriptive statistics were computed using Fishers Exact Test. RESULTS: 217 patients were identified who underwent laparotomy; 144 had a gynecologic malignancy and 73 were benign. 42 had a negative pressure VAC system placed. 14 patients with postoperative wound complications were identified. Various risk factors, including body mass index (BMI), age, smoking, diabetes, coronary artery disease, hypertension, cancer, and blood transfusion were examined. Only obesity (BMI greater than 30) was significantly associated with wound complication (p = 0.02; OR 4.3; 95% CI 1.28-14.81). However, only 3 out of the 14 patients that had wound infections had a negative pressure VAC. The average BMI for patients with a negative pressure VAC that did not develop a wound complication was 37.6 plus or minus 9.5, however it was 46.8 plus or minus 11.6 (P less than 0.0001) for those that did. CONCLUSION: Obese patients have a higher risk for postsurgical wound complications. Negative pressure VAC therapy could be a preventative measure for obese patients with gynecologic malignancies undergoing laparotomy. Further study is warranted to determine whether closed incision negative pressure therapy reduces the rate of wound complications.