53.04 Standardized Negative Pressure Wound Therapy Decreases Days of Vac Use in Acute Care Surgery

Posted on January 26, 2017

M. J. Forestiere1, R. C. Frazee1, C. L. Isbell1, T. S. Isbell1, R. W. Smith1, S. W. Abernathy1, Y. Munoz-Maldonado1, J. L. Regner1  1Scott & White Healthcare,General Surgery,Temple, Texas, USA

Introduction:
Surgical site occurrences (SSO) are prevalent in acute care surgery. The increased focus on quality has resulted in more in-patient and out-patient use of Negative Pressure Wound Therapy (NPWT) for surgical wounds. We created a NPWT protocol using Hydrofera Blue® bacteriostatic foam wicks, primary skin staples, and silver impregnated foam overlay to facilitate early wound closure. Our hypothesis is that a standardized NPWT protocol will decrease SSO and days of NPWT use.

Methods:
Retrospective cohort study assessed consecutive emergency celiotomies at our institution from July 1, 2013 – June 30, 2014. Patients under age of 18 were excluded. Included variables were demographics, surgical indication, vasopressor use, wound classification, NPWT days, and SSO. Primary outcomes were SSO [superficial & deep surgical site infection, fascial dehiscence, and return to OR], days of NPWT, and discharged with NPWT. Analysis used exact Chi-square tests between categorical variables, Monte Carlo Kruskal-Wallis tests for analysis of variance for ordinal and categorical variables, and Wilcoxon-Sum-Rank test for total days of NPWT.

Results:
212 patients underwent emergency celiotomy. After excluding clean wounds (n=54), the remaining patients were divided into primary closure only (n=51), traditional NPWT (n=63), and our NPWT protocol (n=43). There was no difference in ASA, BMI, surgical indication, wound classification, or SSO among the three groups. Total NPWT days were reduced in protocol versus traditional NPWT (median=3 vs 20.5 days, range = (3-51) vs (3-405) days, p=0.003). Fewer patients were discharged home with NPWT in the protocol vs traditional NWPT (14 vs 63.5%, p<0.0001, OR=10.7, 95% CI [3.7–35.1]).

Conclusion:
Protocol driven NPWT decreases NPWT usage days and maintains low surgical site occurrences. National adoption of this protocol has the potential to reduce healthcare costs and improve quality outcomes.