Incisional Negative Pressure Wound Therapy Use to Reduced Surgical Site Complications in Lung Transplant Patients

Abstract

Purpose Surgical site infections and wound dehiscence in lung transplant recipients are known potential complications that are costly for both patients and health care systems. It was hypothesized that placing an incisional negative pressure wound therapy device at time of skin closure in the operating room could reduce surgical site complications. Methods Single center, retrospective analysis of surgical site complications. Historic cohort consisted of all patients transplanted at our center from March 2014, which is when we began formally documenting our complication rates, to July 2017. No patients were excluded from this group. An incisional negative pressure wound therapy system was placed over the surgical incision site of all lung transplant recipients at our center from August 2017 to July 2018 and remained until POD 7. Presence of surgical site complications were evaluated at POD 30 and 90. Patients were excluded who did not have device on at POD 7. Results The historic cohort consisted of 67 patients, 52% male,48% female with mean BMI 25 and mean age of 56. Indication for lung transplantation: primarily COPD (56%) followed by ILD (23%). Single lung transplant was performed on 4 (6%) and 63 (94%) received double lung transplant. In this group, there were 7 (10%) surgical site complications at a rate of 7.2 per 1,000 patient days, one of which was a deep surgical site infection. Of the 24 patients eligible to receive the superficial negative pressure wound therapy, 19 were able to be included in this study. The primary reason for exclusion was device inability to hold suction. Of this cohort, 56% were male and 44% were female with mean BMI 27 and mean age of 57. Indication for lung transplantation: primarily ILD (46%) followed by COPD (25%). Single lung transplant was performed on 4 (6%) and 14 (78%) received a double lung transplant. In this group, there was only 1 (5%) surgical site complications at a rate of 2.7 per 1,000 patient days. All patients tolerated the therapy and there were no negative effects associated with the therapy. Of note, of the 5 patients that were excluded, one patient did develop superficial dehiscence. Conclusion Implementing prophylactic incisional negative pressure wound therapy is a safe, well tolerated intervention that shows potential at reducing rates of surgical site complications in lung transplant patients.