Retrospective Cohort Study: Negative Pressure Wound Treatment for Surgical Site Infection After Radical Cystectomy
Objectives: The negative pressure wound therapy (NPWT) is a well‐established advanced for treatment surgical site infections (SSI) such as wound suppuration, postoperative peritonitis or open abdominal. How-ever, the evidence base for use for complications in oncological surgery is very limited. Therefore, in this study assessed the 30-days results of NPWT in treatment SSI in oncological surgery.
Methods: This is a retrospective cohort study which was performed in accordance with the STROBE protocol. The study included data of 446 patients who were underwent to radical cystectomy with uroderivation (RC) at the Oncourology department between January 2012 and December 2021. For next analysis 62 cases of SSI were allocated with completely data. These cases were separated into two groups: group A (n=36) of standard SSI's management and group B (n=26) of NPWT-dressing with VivanoTec® S042 device in constant negative pressure mode (85-110 mmHg). All calculations were performed with MS Excel and StatPlus:mac (2022).
Results: SSIs were identified in 57 men (91.93%) and 5 cases in women (8.07%). The age, BMI in both groups did not differ. There was a statistically significant increase in CRP at the time of detection of SSI in group D - 233.72±139.67 mg/ ml (p=0.011). It was confirmed by the severity of the process according to the APACHE scale and correlation analysis (r=0.318, p=0.011). The mortality rate dur-ing hospitalization did not differ between groups. When conducting a oneway analysis of variance in groups A and B, no convincing data were obtained on the effect of NPWT on mortality (F=2.68 p=0.106).
Conclusion: The NPWT dressing does not negatively affect on incidence of postoperative mortality, intestinal fis-tulas or lateralization of wound edges. The method showed identical results in comparison with the standard method, despite the inclusion cases with more severe inflammatory processes (90% of pa-tients with APACHEII scale > 20 points).
1. Witjes J.A. et al. EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer 2022 [Electronic resource]. European Association of Urology. Arnhem, 2023.https://d56bochluxqnz. cloudfront.net/documents/full-guideline/EAU-Guidelines-on Muscle-Invasive-AndMetastatic-Bladder-Cancer-2023.pdf. – Date of access: 09.09.2023.
2. Nosov AK, Reva SA, Dzhalilov IB, Petrov SB. Radical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgery. Cancer Urology. 2015;11(3):71-78. (Russian)
3. Perlin DV, Alexandrov IV, Zipunnikov VP, Shmanev AO. Laparoscopic radical cystecto-my: key points. Cancer Urology. 2018;14(1):136-143 (Russian)
4. Kotov SV, Khachatryan AL, Zhuravleva AK, Sargsyan ShM. Comparative analysis of peri-operative results of open and laparoscopic radical cystectomy with the formation of ileocon-duit. Experimental and clinical urology. 2022; 1(15):38-44; (Russian) doi:10.29188/2222-8543-2022-15-1-38-44
5. Lawrentschuk N, Colombo R, Hakenberg OW, Lerner SP, Månsson W, Sagalowsky A, Wirth MP. Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol. 2010;57(6):983-1001. doi: 10.1016/j.eururo.2010.02.024.
6. Gupta S, Gabriel A, Lantis J, Téot L. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J. 2016;13(2):159-74.
7. Gain YM, Bordakov PV, Bordakov VN, Shakhrai SV, Gain MY, Elin IA. Vacuum therapy of wounds for surgical infection of soft tissues. Medicine. 2016; 3:64-72. (Russian)
8. Gao J, Wang Y, Song J, Li Z, Ren J, Wang P. Negative pressure wound therapy for surgi-cal site infections: A systematic review and meta-analysis. J Adv Nurs. 2021;77(10):3980-3990. doi: 10.1111/jan.14876.
9. Merkow R.P, Ju M.H., Chung J.W. Underlying reasons associated with hospital readmis-sion following surgery in the USA. JAMA. 2015; 313(5):483-495.
10. Sax H, Uçkay I, Balmelli C. Overall burden of healthcare-associated infections among sur-gical patients. Results of a national study. Ann Surg. 2011;253(2):365-370.
11. von Elm E., Altman D. G., Egger M., Pocock S. J., Gøtzsche P. C., Vandenbroucke J. P. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemi-ology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596): 1453–1457
12. Wells G. A., Shea B., O’Connell D., Peterson J., Welch V., Losos M., Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. URL: http:// www.ohri.ca/programs/clinical_epidemiology/oxford. asp
13. Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM. New WHO recommendations on intraoperative and postoperative measures for surgical site infec-tion prevention: an evidence-based global perspective. Lancet Infect Dis. 2016; 16(12): e288-e303. doi: 10.1016/
S1473-3099(16)30402-9.
14. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563-76.
15. Coccolini F, Montori G, Ceresoli M, Catena F, Ivatury R, Sugrue M, Sartelli M, Fugazzola P. International Register of Open Abdomen, preliminary results. World J Emerg Surg. 2017; 12:10. doi: 10.1186/s13017-017-0123-8.
16. Cheng Y, Wang K, Gong J, Liu Z, Gong J, Zeng Z, Wang X. Negative pressure wound therapy for managing the open abdomen in non-trauma patients. Cochrane Database Syst Rev. 2022;5(5):CD013710. doi: 10.1002/14651858
17. Wild T, Stortecky S, Stremitzer S. Abdominal dressing a new standard in therapy of the open abdomen following secondary peritonitis? Zentralblatt fur Chirurgie vol. 131 Suppl 1 (2006): S111-4.
18. Bleszynski MS, Chan T, Buczkowski AK. Open abdomen with negative pressure device vs primary abdominal closure for the management of surgical abdominal sepsis: a retrospective review. American journal of surgery.2016; 211(5):926–932.