Incisional Negative Pressure Wound Therapy Reduces Peripheral Bypass Infection Rates Without Increasing Cost

Abstract

The objective was to evaluate outcomes of negative wound incisional therapy on surgical site infection rates in lower extremity bypass patients. We also wished to determine whether the routine use of negative wound incisional therapy is a cost-effective measure. During a period from May 2018 to August 2018, our institution transitioned to the routine use of negative wound incisional therapy. We elected to retrospectively review our outcomes before and after initiation of negative wound incisional therapy. Group A included patients from September 2017 to April 2018 without wound incisional therapy. Group B included patients from September 2018 to April 2019 with wound incisional therapy. A χ2 analysis was performed, and P value was set at < .05 to obtain statistical significance. Cost analysis was separately performed using hospital metrics. There were a total of 102 patients in group A and 113 patients in group B. The overall surgical site infection rate for group A was 11.8% (12/102). Group B had an overall surgical site infection rate of 3.5% (4/113; P = .02). Deep infection rate for group A was 7% (7/102). Deep infection rate for group B was 1% (1/113; P = .01; Table I). Cost analysis demonstrated a minimum of $62,000 in infection-related cost savings between groups (Table II). Negative wound incisional therapy has had a profound effect on our practice and has resulted in a decrease in both deep and superficial infections. This has led to a significant cost-effective measure for our institution. We now routinely use negative wound incisional therapy for all lower extremity bypass patients.Table IComplex and overall infection rateBefore prevena - actualAfter prevena actualBefore prevena expectedAfter prevena expectedChi-SqComplex Rate Complex Infection7.001.003.704.3012.07 No Infection9011293.30108.700.016867 Total97.00113.000.05Overall Rate Overall Infection12.004.007.598.4111.47 No Infection9010994.41104.590.021758 total102.00113.000.05 Open table in a new tab Table IICost savingsGroup 1 5 superficial SSI: Total est. cost $25,000 7 deep SSI: Total est. cost $140,000 0 Vascular SSI (graft infection) Total cost = $165,000Group 2 3 superficial SSI: Total est. cost $15,000 1 deep SSI-Total est. cost $20,000 (actual cost was $32,854.44) 0 Vascular SSI (graft infection) Cost of infections = $47,000 Total estimated cost of Prevena device= $55,935 (495/dressing) Total cost= $103,000 Minimum of $62,000 in infection related cost saved between groups Open table in a new tab