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Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR-A Randomized Trial

Svensson Björk, Robert LU orcid ; Hasselmann, Julien LU ; Asciutto, Giuseppe LU ; Zarrouk, Moncef LU ; Björk, Jonas LU orcid ; Bilos, Linda LU ; Artai, Pirouzram and Acosta, Stefan LU orcid (2022) In World Journal of Surgery 46. p.3111-3120
Abstract
Background
Surgical site infections (SSI) in the groin after vascular surgery are common. The aim of the study was to evaluate the effect of negative pressure wound therapy (NPWT) on SSI incidence when applied on closed inguinal incisions after endovascular aneurysm repair (EVAR).

Methods
A multicenter randomized controlled trial (RCT). Between November 2013 and December 2020, 377 incisions (336 bilateral and 41 unilateral) from elective EVAR procedures with the primary intent of fascia closure were randomized and included, receiving either NPWT or a standard dressing. In bilateral incisions, each incision randomly received the opposite dressing of the other side, thereby becoming each other’s control. The primary endpoint... (More)
Background
Surgical site infections (SSI) in the groin after vascular surgery are common. The aim of the study was to evaluate the effect of negative pressure wound therapy (NPWT) on SSI incidence when applied on closed inguinal incisions after endovascular aneurysm repair (EVAR).

Methods
A multicenter randomized controlled trial (RCT). Between November 2013 and December 2020, 377 incisions (336 bilateral and 41 unilateral) from elective EVAR procedures with the primary intent of fascia closure were randomized and included, receiving either NPWT or a standard dressing. In bilateral incisions, each incision randomly received the opposite dressing of the other side, thereby becoming each other’s control. The primary endpoint was SSI incidence at 90 days postoperatively, analyzed on an intention-to-treat basis. Uni and bilaterally operated incisions were analyzed separately, and their respective p-values combined using Fisher’s method for combining P-values. Study protocol (NCT01913132).

Results
The SSI incidence at 90 days postoperatively in bilateral incisions was 1.8% (n = 3/168) in the NPWT and 4.8% (n = 8/168) in the standard dressing group, and in unilateral incisions 13.3% (n = 2/15) and 11.5% (n = 3/26), respectively (combined p = 0.49). In all SSIs, bacteria were isolated from incisional wound cultures. No additional SSIs were diagnosed between 90 days and 1 year follow-up.

Conclusions
No evidence of difference in SSI incidence was seen in these low-risk inguinal incisions when comparing NPWT with standard dressings after EVAR with the primary intent of fascia closure. (Less)
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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
World Journal of Surgery
volume
46
pages
3111 - 3120
publisher
Springer
external identifiers
  • scopus:85140221528
  • pmid:36241857
ISSN
1432-2323
DOI
10.1007/s00268-022-06740-5
language
English
LU publication?
yes
id
d2cdce94-9353-4839-81f2-d3ebc78ad6e2
date added to LUP
2022-12-26 19:20:23
date last changed
2025-04-04 14:05:01
@article{d2cdce94-9353-4839-81f2-d3ebc78ad6e2,
  abstract     = {{Background<br/>Surgical site infections (SSI) in the groin after vascular surgery are common. The aim of the study was to evaluate the effect of negative pressure wound therapy (NPWT) on SSI incidence when applied on closed inguinal incisions after endovascular aneurysm repair (EVAR).<br/><br/>Methods<br/>A multicenter randomized controlled trial (RCT). Between November 2013 and December 2020, 377 incisions (336 bilateral and 41 unilateral) from elective EVAR procedures with the primary intent of fascia closure were randomized and included, receiving either NPWT or a standard dressing. In bilateral incisions, each incision randomly received the opposite dressing of the other side, thereby becoming each other’s control. The primary endpoint was SSI incidence at 90 days postoperatively, analyzed on an intention-to-treat basis. Uni and bilaterally operated incisions were analyzed separately, and their respective p-values combined using Fisher’s method for combining P-values. Study protocol (NCT01913132).<br/><br/>Results<br/>The SSI incidence at 90 days postoperatively in bilateral incisions was 1.8% (n = 3/168) in the NPWT and 4.8% (n = 8/168) in the standard dressing group, and in unilateral incisions 13.3% (n = 2/15) and 11.5% (n = 3/26), respectively (combined p = 0.49). In all SSIs, bacteria were isolated from incisional wound cultures. No additional SSIs were diagnosed between 90 days and 1 year follow-up.<br/><br/>Conclusions<br/>No evidence of difference in SSI incidence was seen in these low-risk inguinal incisions when comparing NPWT with standard dressings after EVAR with the primary intent of fascia closure.}},
  author       = {{Svensson Björk, Robert and Hasselmann, Julien and Asciutto, Giuseppe and Zarrouk, Moncef and Björk, Jonas and Bilos, Linda and Artai, Pirouzram and Acosta, Stefan}},
  issn         = {{1432-2323}},
  language     = {{eng}},
  month        = {{10}},
  pages        = {{3111--3120}},
  publisher    = {{Springer}},
  series       = {{World Journal of Surgery}},
  title        = {{Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections Using Fascia Closure After EVAR-A Randomized Trial}},
  url          = {{http://dx.doi.org/10.1007/s00268-022-06740-5}},
  doi          = {{10.1007/s00268-022-06740-5}},
  volume       = {{46}},
  year         = {{2022}},
}