Can Closed Incision Negative Pressure Therapy Impact Post Operative Outcomes in Breast Reconstruction?
Allen Gabriel, MD, FACS1, Steven Sigalove, MD, FACS2, Noemi Sigalove, MD3, Toni Storm Dickerson, MD4, Jami Rice, PA5, G. Patrick Maxwell, MD, FACS1, Leah Griffin, MS6, Mousam Parekh, MS7, David Macarios, MS, MBA7.
1Loma Linda University, Loma Linda, CA, USA, 2DuPage Medical Group/DMG AESTHETICS, Winfield, IL, USA, 3Central DuPage Hospital/Northwestern Medicine, Winfield, IL, USA, 4Compass Oncology, Vancouver, WA, USA, 5PeaceHealth Plastic Surgery, Vancouver, WA, USA, 6Acelity, San Antonio, TX, USA, 7Acelity, Bridgewater, NJ, USA.
PURPOSE: Evidence suggests that incision management with negative-pressure therapy (ciNPT) may provide clinical benefit in various surgical applications such as orthopedic, sternotomy, abdominal wall repairs, colorectal procedures by protecting surgical incisions and removing fluid and infectious materials. This study compares post-operative outcomes including complication rates and drain use among patients using ciNPT* versus standard of care (SOC) after breast reconstruction.
METHODS: This single-site, retrospective cohort study included data for breast reconstruction procedures from October 1, 2013 - March 31, 2016. Data collected included demographics, chemotherapy/radiation exposure, surgical technique, ciNPT use, number of drains, total drain duration, and 90 day post-operative complication rates. Two-sided T-test and Chi-square or Fisher’s Exact tests were performed at α=0.05.
RESULTS: The study included data on 155 patients (ciNPT=64, SOC=91) and 294 breasts (ciNPT=125, SOC=169). There were no significant differences in mean age, BMI, proportion of smokers and patients with hypertension between the two groups. The ciNPT group had a lower proportion of patients that had prior breast surgery and radiation exposure. There were no significant differences in chemotherapy exposure before 1st stage of reconstruction but ciNPT group had lower percentage of patients who had chemotherapy exposure after 1st stage of reconstruction. More patients in the ciNPT group underwent a pre-pectoral technique of breast reconstruction compared to the control group. Complication rates were examined at the breast level. The overall complication rate was 7 (5.6%) in the ciNPT group compared to 24 (14.2%) in the SOC group (p=0.0176). Significant differences were found in the infection rates [0(0%) v. 10(5.9%)], rates of dehiscence [0(0%) v. 11(6.5%)], rates of necrosis [1(0.8%) v. 16(9.5%) and returns to the OR [0(0%) v. 11(6.5%)] when comparing the ciNPT and SOC groups respectively. All patients in the ciNPT group had 2 drains compared to 81.7% of the Soc group (p<0.0001). The ciNPT group had significantly lower mean drain days per-drain (6.1 vs. 9, p<0.0001) and total drain days (12.2 vs. 18.1, p<0.0001) compared to SOC group.
CONCLUSION: Our study demonstrated significantly lower complication rates and drain duration among the ciNPT group. These results may translate to improved patient outcomes and efficient use of resources in a hospital setting. Further studies are needed to corroborate the findings in our study.*ciNPT=PREVENA™ Therapy
|SOC N = 169 n (%)||ciNPT N = 125 n (%)||p-value|
|Any complication||24 (14.2%)||7 (5.6%)||0.0176|
|Surgical site infection||10 (5.9%)||0 (0%)||0.0059|
|Dehiscence||11 (6.5%)||0 (0%)||0.0030|
|Necrosis||16 (9.5%)||1 (0.8%)||0.0016|
|Seroma||7 (4.1%)||1 (0.8%)||0.1442|
|Hematoma||4 (2.4%)||5 (4.0%)||0.5024|
|Tissue expander exposure||3 (1.8%)||0 (0%)||0.2643|
|Return to operating room||11 (6.5%)||0 (0%)||0.0003|
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