title: Preventive NPWT over closed incisions in general surgery: does age matter?
abstract: Surgical site events (SSE), including surgical wound complications and surgical site infections, are a major concern in patients undergoing general surgery operations. These increase the costs of care, and can lead to prolonged hospital stay and need for further treatments, ultimately resulting in poor quality of life. Negative pressure wound therapy (NPWT) has been recently reported as a preventive strategy to avoid SSE, but little is known on the topic, and particularly in geriatric population. Our primary aim was to assess the efficacy of NPWT by means of a pocket device (PICO, Smith & Nephew, London, UK) in preventing SSE compared with conventional dressings in patients undergoing surgery with primary wound closure for breast and for colorectal diseases in our Unit. Our secondary aims were to assess the efficacy and safety of PICO in elderly patients, and to seek for differences between breast and abdominal results. All consecutive patients undergoing breast and colorectal surgery in our Unit between September 2012 and May 2014 were prospectively enrolled in this open label controlled study. Breast patients receiving NPWT were assigned to group B1, those receiving conventional dressings were assigned to group B2. Colorectal patients were assigned to group C1 (NPWT) and C2 (conventional dressings) in similar fashion. Each group included 25 patients, and at least 10 (40%) patients aged over 65 years to allow sub-analyses. NPWT significantly reduced SSE in both breast and colorectal patients compared with controls. No significant differences were observed according to age. Similar benefits were observed in breast and colorectal patients. Our results suggest that PICO is an effective tool to prevent SSE in patients undergoing general surgery, irrespective of age. Its use is recommended in frail, elderly patients at risk of SSE.
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: gipe1984@gmail.com.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pellino
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: guido.sciaudone@unina2.it.
authors.forename: Guido
authors.initials: G
authors.lastname: Sciaudone
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: g.candilio@alice.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Candilio
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: seredefa@gmail.com.
authors.forename: G Serena
authors.initials: GS
authors.lastname: De Fatico
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: isabella.landino@fastwebnet.it.
authors.forename: Isabella
authors.initials: I
authors.lastname: Landino
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: angeladellacorte@live.it.
authors.forename: Angela
authors.initials: A
authors.lastname: Della Corte
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: raffaella.guerniero@libero.it.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Guerniero
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: raffaella.benevento@gmail.com.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Benevento
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: antonio.santoriello@unina2.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Santoriello
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: ferdinando.campitiello@unina2.it.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Campitiello
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: fselvaggi@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Selvaggi
authors.affiliation: Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, Second University of Naples, Naples, Italy. Electronic address: silvestro.canonico@unina2.it.
authors.forename: Silvestro
authors.initials: S
authors.lastname: Canonico
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001458:Bandages; D001941:Breast Diseases / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation / Q000379:methods*; D011788:Quality of Life; D012002:Rectal Diseases / Q000601:surgery; D049291:Seroma / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: Breast; Colorectal surgery; Complication; Negative pressure wound therapy; SSI; Surgical site event; Surgical site infection