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EFFECT OF NEGATIVE PRESSURE WOUND THERAPY ON WOUND COMPLICATIONS FOLLOWING PANCREATECTOMY
Michael Kuncewitch*1, Aaron Blackham2, Clancy J. Clark1, Rebecca M. Dodson1, Gregory Russel3, Edward Levine1, Perry Shen1
1Surgical Oncology, Wake Forest School of Medicine, Winston Salem, NC; 2Surgical Oncology, Lehigh Valley Physician Group, Allentown, PA; 3Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC
Introduction: Wound complications in the acute and chronic setting are a source of considerable morbidity and cost to patients and health care systems. The prophylactic application of negative pressure wound therapy (NPWT) at the time of primary skin closure has been used with increasing frequency in attempts to decrease these events. We investigated the effects of NPWT on short- and long-term wound outcomes in patients undergoing pancreatectomy.
Methods: A randomized controlled trial comparing the effect of NPWT to standard surgical dressing (SSD) on wound outcomes was performed in 265 high-risk surgical oncology patients undergoing laparotomy from 2012 to 2016. There were 73 patients in the study who underwent pancreatectomy and were randomized to SSD or NPWT. Postoperative wound complications in the first 30 days and incisional hernia rates were assessed. Secondary outcomes evaluated were rates of pancreatic fistula and delayed gastric emptying.
Results: In the SSD (n=37) and NPWT (n=36) cohorts, the superficial SSI, deep SSI, seroma, and dehiscence rates were 16% and 14% (p>0.99), 5% and 8% (p=0.67), 16% and 11% (p=0.74), and 5% and 3% (p=>0.99), respectively. The rates of incisional hernia were 32% and 14%, between the SSD and NPWT groups, respectively (p=0.067). Pancreatic fistula (22% and 31%, p=0.43) and delayed gastric emptying (11% and 8%, p>0.99) also demonstrated no significant difference in the SSD and NPWT arms. These findings were true irrespective of the type of pancreatic resection performed.
Conclusion: Both short- and long-term wound complications were not improved with NPWT after pancreatectomy. There was a trend towards decreased incisional hernia rates in patients treated with NPWT. Further study is needed to better assess the impact of NPWT on wound outcomes after pancreatectomy.
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