Presentation Authors: Gregory Joice*, Baltimore, MD, Giorgia Tema, Rome, Italy, Alice Semerjian, Mohit Gupta, Michael Bell, Joanne Walker, Max Kates, Trinity Bivalacqua, Baltimore, MD
Introduction: Surgical Site Infection (SSI) is a significant complication after radical cystectomy (RC) with rates estimated between 10 and 30%. Enhanced Recovery after Surgery (ERAS) focuses on interventions to improve return of bowel function and decrease hospital length of stay (LOS) but few address SSIs directly. There is early evidence in general surgery that incisional negative-pressure wound therapy (iNPWT) may decrease wound related complications.
Methods: As part of our RC ERAS pathway, we employ iNPWT during abdominal closure. After closure of the fascia and deep dermal layers of the abdominal wall, an iNPWT dressing is applied over a protective antimicrobial non-adherent contact dressing. The dressings are changed after postoperative day 3 and removed prior to discharge. We retrospectively reviewed patients undergoing RC with urinary diversion by a single-surgeon from 2014-2017. We compared 90 day SSIs, Surgical Site Occurrences (SSOs), and readmissions between iNPWT and standard skin staple closure. SSOs were defined as SSI, seroma, or superficial wound dehiscence.
Results: We identified 158 (104 iNPWT, 54 standard) patients from 2012 to 2017. There was no difference in terms of age (70.5 vs 69.7 years, p = 0.62), BMI (28.2 vs. 27.9 kg/m2, p = 0.81), or diabetes (24.0% vs 16.7%, p = 0.29). The rates of SSI/SSOs were 9.7% and 19.0%, respectively. The readmission rate was 21.5% with 4.4% readmitted for SSI. The iNPWT group had a significantly lower rate of SSIs (5.8% vs. 16.7%, p = 0.03) and SSOs (11.5 vs. 33.3%, p < 0.01). There was no difference between the two groups for readmission (21.1 vs. 22.2%, p = 0.5) or SSI-specific readmission (3.9% vs. 5.6%, p = 0.62). On multivariable analysis, female patients and obese patients were more likely to experience SSI/SSOs. iNPWT significantly protected against both SSI (OR 0.89, 95% CI: 0.81-0.98) and 90-day SSO (OR 0.77, 95% CI: 0.68-0.87) but not readmissions (OR 1.01, 95% CI: 0.87-1.18) or SSI specific readmission (OR 0.97, 95% CI: 0.91-1.04).
Conclusions: Prophylactic iNPWT is feasible after RC with urinary diversion with and shows a modest decrease in 90 day SSIs and SSOs. iNPWT assisted wound closure should be as a component of RC ERAS protocols.