May 31st, 2016

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Effect of Single-Use Negative Pressure Wound Therapy on Postcesarean Infections and Wound Complications for High-Risk Patients
Authors:  Sara H. Swift, M.D., M. Bridget Zimmerman, Ph.D., M.S., and Abbey J. Hardy-Fairbanks, M.D.
  OBJECTIVE: To evaluate the effect of a single-use negative pressure wound therapy (NPWT) system on postoperative complications after cesarean delivery.

STUDY DESIGN: A historical control cohort of women was collected as part of a quality improvement project over a 6-month period. All women with at least 1 risk factor for postoperative complications were included in this control cohort. An intervention cohort of 110 women with at least 1 risk factor for postoperative complications was eligible to have a single-use NPWT system placed at the time of cesarean delivery. Primary outcomes were wound/infectious morbidity, including any surgical site infection (deep or superficial) as defined by the Centers for Disease Control, or wound separation without infection.

RESULTS: Despite significantly higher overall burden of risk factors for postoperative complications, the intervention group showed a significantly lower rate (21.0% vs. 6.4%, p=0.0007) of overall wound/infectious morbidity. The rate of isolated wound separation between the 2 groups was not statistically significant (3.8% vs. 2.7%, p=0.754) and was likely due to the low rate of wound separations.

CONCLUSION: Application of an NPWT system to a primarily closed cesarean incision at time of surgery significantly decreased both deep and superficial infectious morbidity in our intervention group, which had more risk factors for wound complications and postoperative infection.
Keywords:  cellulitis, cesarean section, endometritis, endomyometritis, negative-pressure dressings, negative-pressure wound therapy, postcesarean section, Prevena, seroma, topical negative-pressure therapy, vacuum-assisted closure, wound infection
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