LAUSR

Study Objective Identify whether incisional (or prophylactic) negative-pressure wound therapy (iNPWT) is associated with reduced wound complications. Design Retrospective cohort study. Setting Quaternary referral academic center. Patients or Participants Included patients underwent an open abdominal procedure for a gynecologic indication with a gynecologic primary surgeon between July 1, 2015 and June 30, 2017. Type III or IV incisions were excluded. A total of 568 patients met inclusion criteria. Interventions iNPWT placed over a closed incision. Measurements and Main Results We compared our intervention group of patients who had 1+ additional risk factor and received iNPWT (Group A) to a group of patients managed by gynecologic surgeons who never use iNPWT (Group B) and to a cohort who did not receive iNPWT, but were managed by gynecologic surgeons who use iNPWT (Group C). The primary outcome was a composite of wound complications, including surgical site infections (SSIs), hematomas, seromas, or wound separations, within 30 days following surgery. Results were adjusted using inverse probability weighting. The unadjusted wound complication rates were 18.3%, 13.4% and 16.8%, in Groups A (N=71), B (N=283), and C (N=214), respectively, and were not significantly different. The adjusted rates were similar for overall wound complications but did show a lower SSI rate between Groups A and B (6.7% vs 8.2%) and groups A and C (5.0% vs 10.0%). A subgroup of patients with a BMI >40 kg/m2 and 1 additional risk factor showed similar SSI rates (10.5% vs 10.3%) between Groups A and C, and a lower rate in Group A when compared to Group C (10.5% vs 20.0%). However, SSI rate differences did not reach statistical significance due to low numbers. Conclusion There was no difference in overall wound complication rates among patients receiving iNPWT. Lower SSI rates were seen although statistical significance was not reached. iNPWT as an intervention may impact SSIs more than hematomas, seromas, and wound separations.