A randomized clinical trial evaluating negative pressure therapy to decrease vascular groin incision complications

Area of Science:

• Vascular Surgery
• Wound Management
• Medical Devices

Background:

• Vascular groin incision complications increase patient morbidity and healthcare expenses.
• Negative pressure therapy (NPT) has demonstrated efficacy in reducing infection rates in cardiac and orthopedic procedures.
• Evaluating NPT for vascular groin incisions is crucial for improving patient outcomes and cost-effectiveness.

Purpose of the Study:

• To prospectively evaluate the efficacy of negative pressure therapy in decreasing wound complications and associated healthcare costs in patients undergoing vascular groin surgery.
• To compare the outcomes of standard gauze dressing versus NPT in high-risk patient populations.

Main Methods:

• A randomized, prospective, single-institution study involving 119 patients with femoral incisions after elective vascular surgery.
• Patients were categorized as high-risk based on factors like BMI >30 kg/m², pannus, reoperation, prosthetic graft, poor nutrition, immunosuppression, or HbA1c >8%.
• Incisions were randomized to standard gauze dressing (n=60) or NPT (Prevena, n=59), with outcomes including wound complication rate, length of stay, reoperation, readmission, and costs assessed over 30 days.

Main Results:

• High-risk patients receiving standard care had a major wound complication rate of 25%, with significant increases in length of stay, reoperation, readmission, and costs.
• Negative pressure therapy significantly reduced major wound complications to 8.5% (P < .001), reoperations to 8.5% (P < .05), and readmissions to 6.8% (P < .04).
• NPT resulted in an average cost reduction of $6045 per patient, although the difference in length of stay was not significant.

Conclusions:

• Negative pressure therapy is effective in significantly reducing major wound complications, reoperations, and readmissions for high-risk vascular groin incisions.
• The use of NPT for high-risk groin incisions is recommended to improve patient outcomes.
• NPT demonstrates potential for reducing overall hospital costs associated with vascular groin wound complications.