The following summary comes from Javed et al. and was recently published in the Annals of Surgery, the preeminent surgical journal, in June 2019.
Despite a substantial decreased in the mortality associated with the Whipple procedure, postoperative complications, albeit non-life-threatening are frequently observed. Surgical site infections are a common complication, and in the immediate postoperative period add morbidity and in the long run can impact long-term outcomes in patients with pancreatic cancer due to delays in receipt of systemic therapy after surgery. Simply put, a surgical site infection occurs when pathogens such as bacteria infect the incision site. In case of a surgical site infection, in the days following the surgery, the incision often becomes tender, swollen and red, and purulent discharge may be observed. Management of this complication can range from antibiotic administration to need for a reoperation, depending on its severity. Surgical site infections can prolong hospitalization, result in readmissions, and increase healthcare costs. Individuals considered “high risk” for surgical site infections are those who have either undergone preoperative stenting of the bile duct or received neoadjuvant chemotherapy, or both. In this population the rate of surgical site infections of over 30% has been reported.
Given this knowledge, this study sought to evaluate the impact of negative pressure wound therapy (sometimes referred to as “wound vacs”) on the rate of this complication. The authors conducted a randomized controlled trial evaluating the benefit of using this device in high risk patients. Patients were randomly assigned to receive the device or a standard wound closure. The device consists of a foam dressing over the incision that is connected to vacuum suction via tubing and works by keeping the incision dry (less favorable for growth of pathogens).
Over a one-year period, 123 high risk patients who underwent Whipple procedure were included in the study. Surgical site infection occurred in 9.7% (6/62) of patients who received the device and in 31.1% (19/61) of patients in the standard closure group (P = 0.003). The relative reduction in risk of developing surgical site infection was 68.8%. Furthermore, on cost analysis surgical site infections were found to independently increase the cost of hospitalization by approximately 23.8%.
The use of negative pressure wound therapy resulted in a significantly lower risk of SSIs. Incorporating this intervention in surgical practice can help reduce a complication that significantly increases postoperative morbidity and healthcare costs.
Take home points:
- Surgical site infections are common, especially in high risk patients following the Whipple procedure.
- Negative pressure wound therapy (or wound vacs) can lower the risk of surgical site infections in high risk patients by almost 70%.
Image- KCI Negative Pressure Wound Therapy dressing. Image credit: https://www.kci-medical.sg/SG-ENG/vactherapy