Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience.
BACKGROUND
Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.


OBJECTIVE
To assess the incidence of wound infection and dehiscence in patients undergoing long-segment thoracolumbar fusion before and after the routine use of NPWT.


METHODS
Retrospective study.


METHODS
One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.


METHODS
Postoperative incidence of wound infection and dehiscence.


METHODS
All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.


RESULTS
One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).


CONCLUSIONS
Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.
Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA. Electronic address: owoicho.adogwa@gmail.com.
Owoicho
O
Adogwa
Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA.
Parastou
P
Fatemi
Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA.
Edgar
E
Perez
Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA.
Jessica
J
Moreno
Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA.
Gustavo Chagoya
GC
Gazcon
Department of Neurosurgery, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA.
Ziya L
ZL
Gokaslan
Department of Neurosurgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA.
Joseph
J
Cheng
Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA.
Oren
O
Gottfried
Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA.
Carlos A
CA
Bagley
D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects*; D013123:Spinal Fusion / Q000009:adverse effects*; D013530:Surgical Wound Infection / Q000209:etiology*
Deformity; Negative pressure wound therapy; Spine outcomes; Surgical site infections; Wound dehiscence; Wound infection