LINK Scientific Content – Congress Abstract

The risk of surgical site infection (SSI) and SSI prevention with closed incision negative pressure therapy (ciNPT)

Scientific Content

The risk of surgical site infection (SSI) and SSI prevention with closed incision negative pressure therapy (ciNPT)

Type
Congress Abstract
Language
EN
Publication Year
2017
Author(s)
Christian Willy
Approx. reading time
5 min

Introduction

Despite the many scientific technological advances, such as the advent of antibiotics, highlevel preclinical and intensive medicine, SSI continues to be a problem that haunts orthopaedic and trauma surgeons. There is a need for a comprehensive knowledge regarding risk factors (RF) and possible preventive measures to control SSI. Commercially available ciNPT may offer surgeons an additional option to manage clean, closed surgical incisions.

Methods

Medline literature search and analysis (EndNote / PubMed) 1968-2017 (as of march 1st 2017). Used keywords were (filter „title“): "surgical site infection" OR "postoperative infection". Trauma and orthopaedic associated risk factors were selected. Additionally, a literature search was performed using key words ‘prevention’, ‘negative pressure wound therapy (NPWT)’, ‘active incisional management’, ‘incisional vacuum therapy’, ‘incisional NPWT’, ‘incisional wound VAC’, ‘closed incisional NPWT’ published from 2000 to 2015.

Results

Identification of 858 relevant articles from the 50 years 1968-2017. Pooled SSI rate is 0,3% (hand surgery) and 19% (III° open fractures). For open fractures, there is no clear tendency towards lower infection rates during the past five decades. Identification of 115 RFs is possible from three subject areas (patientdependent, organizational and procedural, trauma and operation dependent). The five most important RF are
body mass index over 35 (kg/m2), increased duration of surgery, diabetes mellitus, increased blood glucose levels in the perioperative period even in the case of non-diabetics and errors in the perioperative antibiotic prophylaxis. The ciNPT search found >100 publications that fulfilled the search criteria. Based on higher evidence, high-risk incisions (sternotomy and incisions in extremities after high-energy open trauma) are principally recommended for ciNPT use. In 'lower'-risk incisions, the addition of patient-related or operationrelated risk factors justifies the application of ciNPT.

Discussion/Conclusion

Inconsistent definition of "infection", interaction of the RF and the different followup duration limit the meaningfulness of the study. In the future considerable efforts must be made in order to achieve a noticeable reduction in the rate of infection, especially in the case of high risk patients. One successful option is ciNPT.

Authors

Christian Willy
Department of Traumatology / Orthopaedic Surgery, Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin

References

  1. Willy C, Rieger H, Stichling M (2017) [Prevention of postoperative infections : Risk factors and the current WHO guidelines in musculoskeletal surgery]. Unfallchirurg 120(6):472-485
  2. Willy C, Agarwal A, Andersen CA, Santis G, Gabriel A, Grauhan O, et al. (2017) Closed incision negative pressure therapy: international multidisciplinary consensus recommendations. Int Wound J 14(2):385-398
  3. Apelqvist J, Willy C, Fagerdahl AM, Fraccalvieri M, Malmsjo M, Piaggesi A, et al. (2017) EWMA Document: Negative Pressure Wound Therapy. J Wound Care 26(Sup3):S1-S154
  4. Willy C, Engelhardt M, Stichling M, Grauhan O (2016) The impact of surgical site occurrences and the role of closed incision negative pressure therapy. Int Wound J 13 Suppl 3:35-46

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