The use of negative pressure wound therapy to prevent post-operative surgical site infections following pancreaticoduodenectomy

Abstract

Objective: Rates of superficial surgical site infection (SSI) following pancreaticoduodenectomy remain high despite significant investment in process measures aimed at reducing perioperative infectious complications. Following resection for cancer, complications such as SSI impact adjuvant therapy delivery and portend worse survival. The utilization of an incisional negative pressure dressing (iVAC) has been demonstrated to reduce SSI in other high-risk cohorts. Methods: Following a comprehensive effort to identify patients at high risk for SSI, practice patterns at a single academic center shifted and iVAC use increased. Data regarding SSI were collected in a prospectively maintained database. Individualized patient risk and SSI rate in the cohort receiving iVAC was compared to the cohort receiving standard closure. Results: In total, 436 patients underwent pancreaticoduodenectomy over 21-months. An iVAC was used in 120 patients (27.5%). The overall rate of SSI was 20%. On multivariate analysis, increased risk for SSI was associated with neoadjuvant therapy, preoperative biliary interventions and prior abdominal surgery. Obese patients and patients receiving preoperative biliary intervention were more likely to have an iVAC. Despite this, iVAC use was associated with a decreased rate of SSI (OR 0.45, p < 0.009). In the highest-risk patients, SSI rate was decreased from 49% in patients without an iVAC to 19% with iVAC use (p=0.018). Conclusion: The use of an iVAC following pancreaticoduodenectomy is associated with decreased SSI rates. This is particularly true for patients at highest risk. When integrated with prior work, these data suggest iVAC use may improve adjuvant therapy administration for cancer patients with potential long-term oncologic benefit.Table 1Observed and expected rates of SSI stratified by risk category in patients with and without iVAC placementRisk CategoryˆSSI within 30 days of surgeryp-Value*ExpectedObserved – all patientsObserved – VAC placedObserved – no VAC placed00%29 (13.6%)2 (4.0%)27 (16.5%)0.024132%29 (19.3%)8 (16.3%)21 (20.8%)0.516264%29 (40.3%)4 (19.1%)25 (49.0%)0.018*Comparison between patients who did or did not receive wound VACs.ˆRisk category as defined in prior work [15]. Open table in a new tab *Comparison between patients who did or did not receive wound VACs. ˆRisk category as defined in prior work [15].