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Peritoneal Surface Malignancies

E355: Association of Negative Pressure Wound Therapy (NPWT) and Surgical Site Infections in Patients Undergoing Cytoreductive Surgery

ePoster Presenter(s)

Muhammad Talha Waheed, MD

Research Fellow
Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
Duarte, California, United States

Author(s)

Mustafa Raoof, MD, MS

Assistant Professor
Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
Duarte, California, United States

Author(s)

IM

Ibrahim Malik, MS

Medical Student
School of Medicine, Wayne State University, Detroit, MI, United States
EH

Ernest Han, MD

Associate Professor
Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, United States
Thinzar M. Lwin, MD (she/her/hers)

Assistant Professor
Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, California, United States
IP

Isaac B. Paz, MD

Clinical Professor
Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, United States
Yanghee Woo, MD

Associate Professor
Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
Duarte, California, United States
Laleh Melstrom, MD

Associate Professor
Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA
La Verne, California, United States

Introduction: Surgical site infections (SSIs) after cytoreductive surgery (CRS) are a major cause of potentially avoidable morbidity and health care utilization. NPWT in closed incisions has been associated with a reduction in SSI after certain abdominal operations. However, there is a paucity of data regarding the utility of NPWT in CRS/HIPEC patients. In this study we sought to assess the association of NPWT to SSI in CRS/HIPEC patients.

Methods: This is a retrospective analysis of a prospectively maintained database of consecutive patients undergoing CRS/HIPEC for non-gynecologic cancers from 2009 to 2021 at an NCI-designated comprehensive cancer center. Exposure was defined as the receipt of NPWT vs traditional skin closure (staples or absorbable sutures). Primary outcome was SSI within 90 days of surgery (defined as: wound separation, superficial or deep abdominal wall infection based on ACS-NSQIP definitions). Univariate and multivariate logistic regression models were used to evaluate the association of exposure with outcomes.

Results: A total of 251 patients (median age 56 years; 39% male) were included of which 43 (17%) received NPWT. Overall, 31 (12.3%) patients developed SSIs. Baseline demographics, and clinicopathologic characteristics were similar between the two groups with the following exceptions: Patients who received NPWT had a higher PCI (19 vs 11, p=0.002), higher operative time (10 vs 8.2 hours, p = 0.002), were more likely to undergo splenectomy (37% vs 22%, p< 0.05), distal pancreatectomy (19% vs. 7%, p< 0.05) or formal liver resection (30% vs. 14%, p< 0.05) but less likely to undergo HIPEC (84% vs. 95%, p< 0.05). Compared to traditional closure, receipt of NPWT was associated with a higher but non-significant SSI rate compared traditional closure (16% vs. 11.5%; p=0.25), but a lower 90-day overall complication rate (47% vs. 64%, p< 0.05). However, on multivariate logistic regression accounting for temporal trends, NPWT was not independently associated with 90-day SSI or overall complication rate.

Conclusions: In patients undergoing CRS/HIPEC, NPWT was not associated with a reduction in SSIs or overall complication rate. These findings call the routine use of NPWT into question; and suggest that the previously demonstrated benefit of NPWT in other complex abdominal operations may not extrapolate to patients undergoing CRS/ HIPEC.

Learning Objectives:

Upon completion, participant will be able to describe the role of NPWT in patients undergoing cytoreductive surgery.
Upon completion, participant will be able to question the routine use of NPWT in all patients undergoing cytoreductive surgery.
Upon completion, participant will be able to re-think the utility of NPWT and sought further evidence to establish the need of NPWT in patients undergoing cytoreductive surgery.