O-086 - NEGATIVE PRESSURE WOUND THERAPY AS PREVENTOR OF SURGICAL SITE INFECTIONS AFTER FASCIA CLOSURE IN EVAR - A RANDOMISED MULTI-CENTRE TRIAL

TOPIC:
Wound healing
AUTHORS:
Svensson-Björk R. (Vascular Diseases Research Unit, Department of Clinical Sciences Malmö, Lund University ~ Malmö ~ Sweden) , Hasselmann J. (Vascular Diseases Research Unit, Department of Clinical Sciences Malmö, Lund University ~ Malmö ~ Sweden) , Asciutto G. (Department of Vascular Surgery, Uppsala University Hospital ~ Uppsala ~ Sweden) , Zarrouk M. (Vascular Diseases Research Unit, Department of Clinical Sciences Malmö, Lund University ~ Malmö ~ Sweden) , Björk J. (Division of Occupational and Environmental Medicine, Lund University, ~ Lund ~ Sweden) , Bilos L. (Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital ~ Linköping ~ Sweden) , Pirouzram A. (Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital ~ Linköping ~ Sweden)
Introduction:
Inguinal incisions in vascular surgery are high risk incisions for surgical site infections (SSIs). Negative pressure wound therapy (NPWT) on closed incisions has demonstrated wound protection for SSIs in inguinal incisions, however mainly after open inguinal revascularisation procedures. The SSI incidence after EVAR is lower than after open inguinal revascularisation procedures but still poses a threat to patient morbidity and mortality. NPWT for SSI prevention on inguinal incisions after EVAR procedures has not yet been evaluated.
Methods:
A multi-centre randomised controlled trial including both uni- and bilateral inguinal incision after elective EVAR procedures with the primary intent of fascia closure was conducted. The incisions were randomised to receive either NPWT or a standard dressing. In bilateral incisions, each incision randomly received the opposite dressing of the other side, thereby becoming each other's control. The incisions were then monitored for SSIs for a year postoperatively and analysed per incision. The uni- and bilateral incisions were analysed separately, and their respective p-values combined using Fisher's method. The SSI incidence were reported at 90 days and 1 year postoperatively.
Results:
Between November 2013 and December 2020, 498 incisions (446 bilateral and 52 unilateral) were randomised of which 377 incisions (336 bilateral and 41 unilateral) were included in analysis, thereby reaching the predefined sample size. The SSI incidence at 90 days postoperatively in bilateral incisions was 1.8% (n=3/168) in the NPWT and 4.8% (n=8/168) in the standard dressing group (p=0.18), and in unilateral incisions 13.3% (n=2/15) and 11.5% (n=3/26), respectively (p= 1.0), (combined p=0.49). In all SSIs, bacteria were isolated from incisional wound cultures. No additional SSIs were diagnosed between 90 days and 1 year follow-up. One patient developed an aortic stent graft infection of unknown origin five months postoperatively.
Conclusion:
A non-significant decrease in SSI incidence was seen when comparing NPWT with standard dressings in bilateral incisions. Analysis on an incisional level is the recommended approach when evaluating SSI incidence after EVAR procedures.
ATTACHMENTS: