Prophylactic use of incisional negative pressure wound therapy for the prevention of surgical site occurrences in general surgery: Consensus document

Surgery. 2023 Apr;173(4):1052-1059 doi: 10.1016/j.surg.2022.11.033.
Abstract
BACKGROUND:

Surgical site occurrences pose a threat to patient health, potentially resulting in significant increases in health care spending caused by using additional resources. The objective of this study was to reach a consensus among a group of experts in incisional negative pressure wound therapy to determine the indications for using this type of treatment prophylactically and to analyze the associated risk factors of surgical site occurrences in abdominal surgery.

METHODS:

A group of experts in incisional negative pressure wound therapy from Spain and Portugal was formed among general surgery specialists who frequently perform colorectal, esophagogastric, or abdominal wall surgery. The Coordinating Committee performed a bibliographic search to identify the most relevant publications and to create a summary table to serve as a decision-making protocol regarding the use of prophylactic incisional negative pressure wound therapy based on factors related to the patient and type of procedure.

RESULTS:

The patient risk factors associated with surgical site occurrence development such as age, immunosuppression, anticoagulation, hypoalbuminemia, smoking, American Society of Anesthesiologists classification, diabetes, obesity, and malnutrition were analyzed. For surgical procedure factors, surgical time, repeated surgeries, organ transplantation, need for blood transfusion, complex abdominal wall reconstruction, surgery at a contaminated site, open abdomen closure, emergency surgery, and hyperthermic intraperitoneal chemotherapy were analyzed.

CONCLUSION:

In our experience, this consensus has been achieved on a tailored set of recommendations on patient and surgical aspects that should be considered to reduce the risk of surgical site occurrences with the use of prophylactic incisional negative pressure wound therapy, particularly in areas where the evidence base is controversial or lacking.

Metadata
Organisation: Bueno-Lledo, Jose. Unit of Abdominal Wall Reconstruction, Department of Digestive Surgery, Hospital Universitari i Politecnic "La Fe," University of Valencia, Spain. Electronic address: buenolledo@hotmail.com. Rubio-Perez, Ines. Unit of Colorectal Surgery, Department of General Surgery, Hospital Universitario La Paz, Madrid, Spain. Moreno-Gijon, Maria. Unit of Esophago-Gastric, Bariatric and Abdominal Wall Surgery, Department of Digestive Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain. Olona-Casas, Carles. Unit of Esophago-Gastric and Abdominal Wall Surgery, Department of General and Digestive Surgery, Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigacio Sanitaria Pere Virgili, Spain. Barbosa, Eva. Unit of Complex Abdominal Wall Reconstruction, Department of General Surgery, Centro Hospitalar Universitario Sao Joao, Porto University, Portugal. Molina, Jose Manuel. Complex Abdominal Wall Reconstruction, Hepato-biliary and Pancreatic Surgery Unit, Department of General and Digestive Surgery, Hospital Universitario Ramon y Cajal, Universidad de Alcala de Henares, Madrid, Spain. Castellanos, Gregorio. Department of Surgery, Hospital Clinico Universitario Virgen de la Arrixaca, Universidad de Murcia, Spain.
Funding: Industry funding
Publication type: Guideline
Organ: Kidney; Pancreas; Liver; Simultaneous Kidney/Pancreas; Heart; Heart/Lung; Lung; Intestine; Various
Language: English
MeSH terms: Humans; Negative-Pressure Wound Therapy; Surgical Wound Infection; Consensus; Surgical Wound; Risk Factors; Heart Transplantation; Heart-Lung Transplantation; Kidney Transplantation; Lung Transplantation; Liver Transplantation; Pancreas Transplantation