Evidence-Based Practice
Post-operative surgical site complications (SSCs) represent a significant burden to healthcare systems globally and pose many challenges for patients undergoing Cesarean Section (CS)1-4. The aim of this study was to determine whether the use of a single-use negative pressure wound therapy (sNPWT) system over closed surgical incisions could reduce the incidence of SSCs, the length of hospital stay (LOS), and index admission cost and 30-day costs between two commercially available devices (Device 1* and Device 2**).
Methods:
A retrospective cohort study was performed using Premier PINC AI Healthcare Database (PHD), all payor hospital inpatient admissions between 2017 to June 2022. Patients were identified using ICD-10-PCS and CPT codes and/or billing records while the devices were identified via text search from the hospital billing table on the day of surgery. 1:1 Propensity score matching (PSM) was used, and the following variables were matched: age, gender, myocardial infarction, congestive heart failure, diabetes, obesity, hypertension, Charlson Comorbidity Index, smoking and steroid use. Standardized differences were calculated for the variables included in the PSM model to ensure the matching was balanced.
Results:
After matching, 5332 patients were included for both devices. 5% were smokers and 0.26% vs 0.58% used steroids, 50% were obese. Mean age 30, CCI 0.17 and 0.18. SSI 0.58% vs 0.99% OR 0.58 p=0.018, superficial SSI 0.17% VS 0.43% OR 0.42, p=0.017, dehiscence 1.03% vs 1.69% OR 0.62 p-value 0.005, length of stay 3.39 vs 3.47 days, 2.35% reduction p< 0.10, Index admission cost- $10,613 vs $11,103 (3.83% reduction p< 0.0001, 30-day costs $9,319 vs $9,980 (6.12% reduction, p< 0.0001) infavor of Device 1.
Discussion:
Use of one sNPWT Device 1 reduced SSI, superficial SSI, dehiscence, LOS, and costs compared with Device 2 in CS. This real-world data supports existing recommendations for the use of sNPWT to manage CS incisions to prevent post-operative SSCs.