Effects of Negative Pressure Wound Therapy on Wound Dehiscence and Surgical Site Infection Following Instrumented Spinal Fusion Surgery—A Single Surgeon's Experience

• Published in: World neurosurgery 2020-05, Vol.137, p.e257-e262
• Main Authors: Naylor, Ryan M., Gilder, Hannah E., Gupta, Nikita, Hydrick, Thomas C., Labott, Joshua R., Mauler, David J., Trentadue, Taylor P., Ghislain, Brandon, Elder, Benjamin D., Fogelson, Jeremy L.
• Format: Article
• Language: English
• Subjects: Aged; Case-Control Studies; Cohort Studies; Discitis - surgery; Dura Mater - surgery; Female; Humans; Lumbar Vertebrae - surgery; Male; Middle Aged; Negative-Pressure Wound Therapy - statistics & numerical data; NPWT; Osteomyelitis - surgery; Patient Readmission - statistics & numerical data; Prevention; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Spinal Fusion - methods; Spinal Neoplasms - surgery; Spine fusion; Surgical wound complications; Surgical Wound Dehiscence - epidemiology; Surgical Wound Dehiscence - therapy; Surgical Wound Infection - epidemiology; Surgical Wound Infection - therapy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2020.01.152

Incisional negative pressure wound therapy (NPWT) is used in many surgical specialties to prevent postoperative dehiscence and surgical site infections (SSIs). However, little is known about the role of incisional NPWT in spine fusion surgery. Therefore, we sought to report a single surgeon's experience using incisional NPWT and describe its effects on dehiscence and SSIs after instrumented spine surgery. We compared rates of hospital readmission and return to the operating room for dehiscence and SSIs in a consecutive series of patients who underwent spinal fusion surgery with or without NPWT from 2015 to 2018. A total of 393 patients without and 76 patients with NPWT were included for analysis. Half way through the data collection period, all patients who underwent anterior lumbar fusion received NPWT. Three of 15 (20.0%) of non-NPWT patients who underwent anterior lumbar fusion had dehiscence or SSI compared with zero of 23 (0.0%) of NPWT patients (P = 0.01). NPWT for posterior surgeries was used on a case-by-case basis using risk factors that contribute to SSIs and dehiscence. NPWT patients had higher rates of spinal neoplasia (0.5% vs. 11.3%, P < 0.0001), osteomyelitis/diskitis (1.3% vs. 7.5%, P = 0.02), durotomy (14.9% vs. 28.6%, P = 0.007), revision surgery (32.2% vs. 59.6%, P = 0.0001), and longer fusion constructs (7 vs. 11 levels, P < 0.0001) but had similar rates of dehiscence and SSIs as non-NPWT patients (5.6% vs. 5.7%, P = 0.98). NPWT decreases dehiscence and SSIs in patients undergoing lumbar fusion through an anterior approach. When preferentially used in patients at high risk for postoperative wound complications, NPWT prevents increased rates of dehiscence and SSI.