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Journal article
Prophylactic closed-incisional negative pressure wound therapy following posterior instrumented spinal fusion: a single surgeon’s experience and cost-benefit analysis
Neurosurgical review, v 47(1), 847
15 Nov 2024
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Abstract
Purpose: Surgical site infections (SSIs) following spine surgery are associated with morbidity and resource utilization. Applying prophylactic closed-incisional negative pressure wound therapy (ciNPWT) during posterior instrumented fusion has mixed results in reducing rates of wound complications and SSI. We evaluated the clinical efficacy and potential cost-savings associated with ciNPWT in high-risk patients receiving posterior instrumented spinal fusion. Methods: We retrospectively reviewed patients receiving posterior instrumented spinal fusion for any surgical indication between July 1, 2017 and December 31, 2019, and compared rates of wound dehiscence, SSI, and reoperation for wound complications between standard surgical dressings and ciNPWT. Surgical dressing selection was based on the senior author’s assessment of infection risk factors. Results: A total of 229 patients (n = 85 standard surgical dressings, n = 144 ciNPWT) were included. The ciNPWT group had significantly more risk factors for wound-related complications, including older age (61.8 vs. 58.5 years, p = 0.042), diabetes mellitus (36.8% vs. 23.5%, p = 0.037), more instrumented levels (5.6 vs. 3.9, p < 0.0001), estimated blood loss (1298 vs. 998 mL, p = 0.036), and deformity was the predominant operative indication (29.9% vs. 17.7%, p = 0.040). Prophylactic ciNPWT was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI (8.3% vs. 21.2%, p = 0.005). Number needed to treat with ciNPWT to prevent one SSI was 8 patients. The cost of preventing one SSI was $4,560. Cost-benefit analysis demonstrated a potential mean savings of $21,662 per operative SSI prevented and $270,775 per 100 patients undergoing posterior instrumented fusion with ciNPWT. Conclusions: Prophylactic ciNPWT use is a cost-effective means of reducing rates of wound dehiscence and SSI following posterior instrumented fusion.
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Details
- Title
- Prophylactic closed-incisional negative pressure wound therapy following posterior instrumented spinal fusion: a single surgeon’s experience and cost-benefit analysis
- Creators
- Patrick Chang - Drexel University, College of MedicineDallas E. Kramer - Allegheny Health NetworkRosh Bharthi - Lake Erie College of Osteopathic MedicineDaniel MyersRocco Dabecco - Allegheny General HospitalChen Xu - Allegheny General HospitalAlexander K Yu (Corresponding Author) - Drexel University, Neurosurgery
- Publication Details
- Neurosurgical review, v 47(1), 847
- Publisher
- Springer Nature
- Number of pages
- 7
- Grant note
Thank you to Tyson Barrett for his assistance in obtaining the costs data for this project. The authors thank Sarah Carey, MS, Jade Chang, and Jacalyn Newman, PhD, of Allegheny Health Network's Health System Publication Support Office (HSPSO) for their assistance in editing and formatting the manuscript. The HSPSO is funded by Highmark Health (Pittsburgh, PA, United States of America), and all work was done in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine; Neurosurgery
- Web of Science ID
- WOS:001355593700003
- Scopus ID
- 2-s2.0-85209127849
- Other Identifier
- 991021959014904721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology
- Surgery