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Abstract：
BACKGROUND: Surgical site complications (SSCs) are the most common cause for readmission after total joint arthroplasty (TJA), increasing costs while predisposing to inferior long-term outcomes. Prophylactic use of closed-incision negative pressure therapy (ciNPT) may lower the risk of these complications, especially in high-risk populations, but appropriate-use guidelines are lacking for patients undergoing primary TJA. We sought to develop a risk-stratification algorithm to guide use of ciNPT dressings and test its use in normalizing the rate of superficial SSCs among high-risk groups.
METHODS: We reviewed 323 consecutive primary TJAs, where 38% of those patients considered at elevated risk were risk-stratified to receive ciNPT dressings. An individual risk score was developed, assigning points based on patient-specific risk factors. We identified a historical control population of 643 patients who all received the same postoperative dressing to test the impact of this risk score.
RESULTS: Compared with historical controls, we observed a modest but significant improvement in superficial SSCs after implementation of risk-stratification (12.0% vs 6.8%; P = .013). Among high-risk patients, there was a marked improvement in SSCs when treated prophylactically with ciNPT dressings as compared with historical controls (26.2% vs 7.3%; P < .001). Low-risk patients, who continued to be treated with standard postoperative dressings, demonstrated no significant improvement (8.6% vs 6.5%; P = .344).
CONCLUSIONS: ciNPT dressings are effective at reducing and normalizing risks of superficial SSCs among high-risk primary arthroplasty patients. The proposed risk-stratification algorithm may help identify those patients who benefit most from these dressings.
METHODS: We reviewed 323 consecutive primary TJAs, where 38% of those patients considered at elevated risk were risk-stratified to receive ciNPT dressings. An individual risk score was developed, assigning points based on patient-specific risk factors. We identified a historical control population of 643 patients who all received the same postoperative dressing to test the impact of this risk score.
RESULTS: Compared with historical controls, we observed a modest but significant improvement in superficial SSCs after implementation of risk-stratification (12.0% vs 6.8%; P = .013). Among high-risk patients, there was a marked improvement in SSCs when treated prophylactically with ciNPT dressings as compared with historical controls (26.2% vs 7.3%; P < .001). Low-risk patients, who continued to be treated with standard postoperative dressings, demonstrated no significant improvement (8.6% vs 6.5%; P = .344).
CONCLUSIONS: ciNPT dressings are effective at reducing and normalizing risks of superficial SSCs among high-risk primary arthroplasty patients. The proposed risk-stratification algorithm may help identify those patients who benefit most from these dressings.
摘要：
背景：手术部位并发症（SSC）是全关节置换术（TJA）后再入院的最常见原因，增加成本，同时诱发较差的长期结果。预防性使用闭合切口负压治疗（ciNPT）可降低这些并发症的风险。尤其是在高危人群中，但对于接受原发性TJA的患者缺乏适当的使用指南.我们试图开发一种风险分层算法，以指导ciNPT敷料的使用，并测试其在标准化高危人群中浅表SSC比率中的使用。
方法：我们回顾了323个连续的主要TJA，其中38％的被认为处于高风险的患者接受ciNPT敷料的风险分层。制定了个人风险评分，根据患者特定的风险因素分配点。我们确定了643名患者的历史对照人群，他们都接受了相同的术后敷料，以测试该风险评分的影响。
结果：与历史对照相比，在实施风险分层后,我们观察到浅表SSC有适度但显著的改善(12.0%vs6.8%;P=0.013).在高危患者中，与历史对照相比,用ciNPT敷料预防性治疗时,SSC有显著改善(26.2%vs7.3%;P<.001).低风险患者,他们继续接受标准的术后敷料治疗，无显著改善（8.6%vs6.5%；P=0.344）。
结论：ciNPT敷料可有效降低高危初次关节置换患者浅层SSC的风险并使其正常化。所提出的风险分层算法可能有助于识别从这些敷料中受益最大的患者。
方法：我们回顾了323个连续的主要TJA，其中38％的被认为处于高风险的患者接受ciNPT敷料的风险分层。制定了个人风险评分，根据患者特定的风险因素分配点。我们确定了643名患者的历史对照人群，他们都接受了相同的术后敷料，以测试该风险评分的影响。
结果：与历史对照相比，在实施风险分层后,我们观察到浅表SSC有适度但显著的改善(12.0%vs6.8%;P=0.013).在高危患者中，与历史对照相比,用ciNPT敷料预防性治疗时,SSC有显著改善(26.2%vs7.3%;P<.001).低风险患者,他们继续接受标准的术后敷料治疗，无显著改善（8.6%vs6.5%；P=0.344）。
结论：ciNPT敷料可有效降低高危初次关节置换患者浅层SSC的风险并使其正常化。所提出的风险分层算法可能有助于识别从这些敷料中受益最大的患者。
