Impact of the Negative Pressure Wound Therapy System (PICO 7 Smith and Nephew) on Surgical Site Infections in High-Risk Patients Undergoing Elective Colorectal Resections and Emergency Laparotomy.

Abstract

<h4>Background</h4>Surgical site infections (SSIs) are a significant concern in colorectal surgery, impacting patient outcomes and increasing treatment costs. The study investigates the effect of PICO 7 (Smith & Nephew) dressings, a negative pressure wound therapy (NPWT) system, on the incidence of SSIs in high-risk patients undergoing elective colorectal resections and emergency laparotomies.<h4>Methods</h4>This retrospective cohort study was conducted at the Colorectal Surgery Unit at Russell's Hall Hospital, Dudley, United Kingdom. The cohort included patients who underwent open colorectal resections and emergency laparotomies with PICO 7 dressing following laparotomy wound closure. The primary endpoint was the incidence of SSI within 30 days of surgery. Secondary endpoints included length of hospital stay, frequency of readmissions, episodes of return to theatre, and interventions such as radiological or open drainage of the abscess. Data were compared with existing literature, given the plan was originally to compare outcomes with a cohort managed with conventional dressings.<h4>Results</h4>A total of 27 cases were reviewed where PICO 7 was applied. Of these, 21 were emergency laparotomies, 11 patients had a stoma created, and 16 had abdominal cavity contamination (faecal matter, pus, serous collection). The majority (14 patients) had a body mass index (BMI) >30, and 16 patients had an American Society of Anesthesiologists (ASA) grade 3. Out of these, eight (30%) developed SSIs, including overlaps of dehiscence and deep space infection. The average hospital stay was 17 days, with one patient readmitted with SSI and four requiring interventions such as return to theatre or radiological drainage.<h4>Conclusions</h4>The study found a higher incidence of SSIs (30%) compared to existing literature, despite using NPWT. Contributing factors included perforated viscus, high BMI, multiple comorbidities, and stoma creation. A larger study cohort with a control group is necessary for further evaluation.