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Comparison of Negative-Pressure Vacuum Wound Closure Methods on Postoperative Complications after Open Ventral Hernia Repair.
Katherine E. Poruk*, Karen K. Burce, Nellie Farrow, Caitlin W. Hicks, Said C. Azure, Mohamed E. Sebai, Peter Cornell, Carisa M. Cooney, Frederic E. Eckhauser
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
Introduction: Ventral hernia repair (VHR) is associated with a high rate of postoperative complications including surgical site occurrences (SSO) and infections (SSI). The use of a modified negative-pressure wound closure device (hybrid-VAC or HVAC) after surgery has been shown to decrease the rate of both in the postoperative period, but can be associated with an increased length of stay (LOS). We compared the use of a standard skin-vacuum closure (SVAC) to HVAC with regards to postoperative outcomes after VHR.
Methods: Data was prospectively collected on all patients undergoing open VHR by a single surgeon between January 2012 and November 2015 at a tertiary hospital. All patients underwent closure with either HVAC or SVAC in sequential fashion. Patient demographics, operative data, and 30-day outcomes were evaluated using univariable statistics to compare cohorts.
Results: During the 4-year study period, 197 patients underwent open VHR. HVAC was utilized in 144 patients (73%) while 53 patients (27%) received a SVAC. There was no difference in age, gender, ASA class, or comorbidities between the HVAC and SVAC cohorts (all P>0.05). HVAC patients had a higher BMI compared to SVAC (35.2 kg/m2 vs. 31.4 kg/m2, P=0.01) and were more likely to have a history of wound infection (26% vs. 8%, P=0.005). There was no differences in prior hernia repair attempts between groups (58% vs. 51%, P=0.42) or the rate of clean-contaminated cases (63% vs. 70%, P=0.40). All but one patient underwent VHR with mesh. Mean operative time was shorter for SVAC patients (308 vs. 272 minutes, P=0.05), although there was a trend toward larger mean hernia defect size in the SVAC cohort (228 vs. 281 cm2, P=0.08). There were no significant differences between the HVAC and SVAC cohorts for 30-day SSO (18% vs. 9%, P=0.10), or SSI (6% vs. 2%, P=0.29), and the incidence of SSO and SSI in our population was lower compared to previously reported rates in the literature (range SSO 13-46%, SSI 7-40%). There were also no significant differences in hospital readmission within 30-days (10% vs. 9%, P=0.99), or postoperative complications, including post-operative seroma, enterocutaneous fistula, or wound dehiscence, between cohorts (all P>0.05). Average LOS was decreased with SVAC use (9.1 vs. 14.1 days, P<0.001).
Conclusion: The use of a negative-pressure wound closure device after VHR results in low incidence of 30-day SSO and SSI. The standard SVAC reduces LOS without an increase in postoperative complications or readmission rate compared to the previously-described HVAC, thereby decreasing costs associated with the SVAC. Further study is needed to assess if SVAC use can reduce SSO and SSI rates after other major abdominal operations.
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