Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 Patients
<b>Background</b>: Despite ongoing efforts to improve the pancreaticoduodenectomy technique and perioperative care, surgical site infection (SSI) remains a contributor to morbidity. Efforts to reduce SSI include the use of negative pressure wound therapy (NPWT), but studies and meta-anal...
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2025-03-01
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| author | Jeremy Peabody Sukhdeep Jatana Kevin Verhoeff A. M. James Shapiro David L. Bigam Blaire Anderson Khaled Dajani |
| author_facet | Jeremy Peabody Sukhdeep Jatana Kevin Verhoeff A. M. James Shapiro David L. Bigam Blaire Anderson Khaled Dajani |
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| description | <b>Background</b>: Despite ongoing efforts to improve the pancreaticoduodenectomy technique and perioperative care, surgical site infection (SSI) remains a contributor to morbidity. Efforts to reduce SSI include the use of negative pressure wound therapy (NPWT), but studies and meta-analyses have been met with conflicting results. We aimed to provide an up-to-date large-scale cohort study to assess the impact of NPWT on SSIs. <b>Methods</b>: Utilizing the National Surgical Quality Improvement Program database, we included patients undergoing a pancreaticoduodenectomy between 2017 and 2021 and divided patients into the NPWT and non-NPWT cohorts. A bivariate analysis was performed to compare baseline characteristics and complication rates between the cohorts. Multivariate logistic regression analysis was performed to assess the independent effect of NPWT on 30-day serious complication, 30-day mortality, and the development of deep or superficial SSI. A priori sensitivity analyses were performed in high-risk and malignancy cohorts. <b>Results</b>: Of the 14,044 included patients, 1689 (12.0%) patients had a prophylactic NPWT device, while 12,355 (88.0%) did not. Patients were more likely to have NPWT if they had higher ASA scores, had diabetes, were dialysis-dependent, or had a hard pancreas, but they were less likely if they were a smoker, had steroid use, or had a bleeding disorder. Most complications occurred similarly between the two cohorts, including superficial and deep SSI, but NPWT patients had a longer length of stay (10.4 d vs. 9.5 d, <i>p</i> < 0.001) and higher organ space SSI (22.6% vs. 17.4%, <i>p</i> < 0.001). Following multivariable modeling to control for demographic differences, NPWT was not independently associated with a difference in likelihood of SSI (aOR 0.94, <i>p</i> = 0.691) or serious complications (aOR 0.958, <i>p</i> = 0.669). Furthermore, the sensitivity analyses of both high-risk and malignant subgroup also did not see an independent association of NPWT on the rate of SSI (aOR 0.98, <i>p</i> = 0.898 and 0.96, <i>p</i> = 0.788, respectively). <b>Conclusion</b>: NPWT is used infrequently and is not significantly associated with improved outcomes including in the high-risk or malignant subgroups based on multivariable analysis for surgical site infections nor did it improve the outcomes of 30-day serious complications in these subgroups. Considering this and other studies showing the limited benefit of NPWT in all-comers and in high-risk cohorts, it remains unclear whether NPWT offers benefits following PD. |
| format | Article |
| id | doaj-art-c0f0f44a93b04ec4bccb2b3243b7ff04 |
| institution | OA Journals |
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| spelling | doaj-art-c0f0f44a93b04ec4bccb2b3243b7ff042025-08-20T01:48:54ZengMDPI AGSurgical Techniques Development2038-95822025-03-01141810.3390/std14010008Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 PatientsJeremy Peabody0Sukhdeep Jatana1Kevin Verhoeff2A. M. James Shapiro3David L. Bigam4Blaire Anderson5Khaled Dajani6Department of Surgery, University of Alberta, Edmonton, AB T6G 2R3, CanadaDepartment of Surgery, University of Alberta, Edmonton, AB T6G 2R3, CanadaDepartment of Surgery, University of Alberta, Edmonton, AB T6G 2R3, CanadaDepartment of Surgery, University of Alberta, Edmonton, AB T6G 2R3, CanadaDepartment of Surgery, University of Alberta, Edmonton, AB T6G 2R3, CanadaDepartment of Surgery, University of Alberta, Edmonton, AB T6G 2R3, CanadaDepartment of Surgery, University of Alberta, Edmonton, AB T6G 2R3, Canada<b>Background</b>: Despite ongoing efforts to improve the pancreaticoduodenectomy technique and perioperative care, surgical site infection (SSI) remains a contributor to morbidity. Efforts to reduce SSI include the use of negative pressure wound therapy (NPWT), but studies and meta-analyses have been met with conflicting results. We aimed to provide an up-to-date large-scale cohort study to assess the impact of NPWT on SSIs. <b>Methods</b>: Utilizing the National Surgical Quality Improvement Program database, we included patients undergoing a pancreaticoduodenectomy between 2017 and 2021 and divided patients into the NPWT and non-NPWT cohorts. A bivariate analysis was performed to compare baseline characteristics and complication rates between the cohorts. Multivariate logistic regression analysis was performed to assess the independent effect of NPWT on 30-day serious complication, 30-day mortality, and the development of deep or superficial SSI. A priori sensitivity analyses were performed in high-risk and malignancy cohorts. <b>Results</b>: Of the 14,044 included patients, 1689 (12.0%) patients had a prophylactic NPWT device, while 12,355 (88.0%) did not. Patients were more likely to have NPWT if they had higher ASA scores, had diabetes, were dialysis-dependent, or had a hard pancreas, but they were less likely if they were a smoker, had steroid use, or had a bleeding disorder. Most complications occurred similarly between the two cohorts, including superficial and deep SSI, but NPWT patients had a longer length of stay (10.4 d vs. 9.5 d, <i>p</i> < 0.001) and higher organ space SSI (22.6% vs. 17.4%, <i>p</i> < 0.001). Following multivariable modeling to control for demographic differences, NPWT was not independently associated with a difference in likelihood of SSI (aOR 0.94, <i>p</i> = 0.691) or serious complications (aOR 0.958, <i>p</i> = 0.669). Furthermore, the sensitivity analyses of both high-risk and malignant subgroup also did not see an independent association of NPWT on the rate of SSI (aOR 0.98, <i>p</i> = 0.898 and 0.96, <i>p</i> = 0.788, respectively). <b>Conclusion</b>: NPWT is used infrequently and is not significantly associated with improved outcomes including in the high-risk or malignant subgroups based on multivariable analysis for surgical site infections nor did it improve the outcomes of 30-day serious complications in these subgroups. Considering this and other studies showing the limited benefit of NPWT in all-comers and in high-risk cohorts, it remains unclear whether NPWT offers benefits following PD.https://www.mdpi.com/2038-9582/14/1/8pancreaticoduodenectomynegative pressure wound therapysurgical site infectionpostoperative complication |
| spellingShingle | Jeremy Peabody Sukhdeep Jatana Kevin Verhoeff A. M. James Shapiro David L. Bigam Blaire Anderson Khaled Dajani Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 Patients Surgical Techniques Development pancreaticoduodenectomy negative pressure wound therapy surgical site infection postoperative complication |
| title | Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 Patients |
| title_full | Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 Patients |
| title_fullStr | Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 Patients |
| title_full_unstemmed | Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 Patients |
| title_short | Impact of Negative Pressure Wound Therapy on Outcomes Following Pancreaticoduodenectomy: An NSQIP Analysis of 14,044 Patients |
| title_sort | impact of negative pressure wound therapy on outcomes following pancreaticoduodenectomy an nsqip analysis of 14 044 patients |
| topic | pancreaticoduodenectomy negative pressure wound therapy surgical site infection postoperative complication |
| url | https://www.mdpi.com/2038-9582/14/1/8 |
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