Prophylactic negative-pressure wound therapy using the open method is associated with reduced surgical site infection after emergency lower gastrointestinal surgery: A retrospective cohort study with propensity score analyses.

Abstract

This study investigates the association between prophylactic negative-pressure wound therapy (pNPWT) using the open method and incisional surgical site infection (SSI) following emergency lower gastrointestinal surgery. We retrospectively examined 210 consecutive patients who underwent emergency surgery for lower gastrointestinal tract perforation or necrosis at a single center between January 2018 and March 2023. Outcomes were compared between patients who received pNPWT and those who received conventional wound management. Propensity score analyses included multivariate analysis using the propensity score in the crude cohort, inverse probability of treatment weighting, and 1:2 nearest-neighbor matching. The primary endpoint was the incidence of incisional SSI and the secondary endpoints were wound healing time, postoperative hospital stay, identification of incisional SSI risk factors, and determination of optimal pNPWT management. In the crude cohort (pNPWT = 41, conventional = 169), incisional SSI occurred in 11 (26.8%) and 65 (38.5%) patients, respectively (P = .227). After propensity score analyses, pNPWT was significantly associated with a reduction in incisional SSI, with odds ratios (95% confidence interval) of 0.344 (0.147-0.804; P = .002), 0.260 (0.103-0.794; P = .002), and 0.285 (0.106-0.763; P = .012) in the multivariate analysis, inverse probability of treatment weighting, and propensity score-matched cohort (pNPWT = 30, conventional = 60), respectively. Wound healing time and postoperative hospital stay did not differ significantly between the groups. Risk factors for incisional SSI were poor American Society of Anesthesiologists Physical Status and perforation, with the addition of conventional wound management. Early application of pNPWT (≤2 days postoperatively) further reduced the incidence of SSI (17.6% vs 71.4%; P = .010). In propensity score analyses, pNPWT was associated with a significant reduction in incisional SSI in contaminated abdominal wounds after lower gastrointestinal surgery. Early application may enhance its effectiveness. pNPWT should be considered for high-risk patients undergoing emergency abdominal surgery.