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Abstract：
Introduction Surgical site infections (SSIs) continue to be a challenging issue among patients undergoing pancreatectomy. Anecdotally, the use of negative pressure wound therapy (NPWT) following pancreatectomy for cancer has been associated with decreased SSIs. The objective of this study was to compare the postoperative outcomes of NPWT and non-NPWT for incisional wound care following distal pancreatectomy or pancreatoduodenectomy for pancreatic diagnoses using a national surgical database. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried from 2005 to 2019 for patients undergoing distal pancreatectomy or pancreaticoduodenectomy for pancreatic diagnoses using primary Current Procedural Terminology (CPT) codes. The primary outcome was surgical site infection rates between NPWT and non-NPWT patient groups. Secondary outcomes include sepsis, septic shock, readmission, and reoperation. Outcomes of interest were compared using multivariate logistic regression. Results A total of 54,457 patients underwent pancreatectomy with 131 receiving NPWT. Multivariate analysis, while accounting for patient characteristics, including wound classification, showed no difference in postoperative superficial SSI, deep SSI, sepsis, septic shock, or readmission between the NPWT and non-NPWT groups. Organ space SSI was higher in the NPWT group (21% vs 12%, p=0.001). Reoperation related to procedure was also high in the NPWT group (14% vs 4.3%, p<0.001). Conclusion The use of NPWT in distal pancreatectomies and pancreatoduodenectomies is associated with increased organ space SSIs and reoperation rates, with no difference in superficial SSI, deep SSI, or readmission. This large sample study shows no significant benefit of using NPWT incisional wound care after pancreatectomy.
摘要：
背景技术手术部位感染(SSIs)在接受胰腺切除术的患者中仍然是具有挑战性的问题。有趣的是，胰腺切除术后使用负压伤口治疗(NPWT)治疗癌症与SSI降低相关.这项研究的目的是使用国家外科数据库比较远端胰腺切除术或胰十二指肠切除术后切口伤口护理的NPWT和非NPWT的术后结果。方法2005年至2019年，美国外科医生学会国家外科质量改进计划（ACS-NSQIP）对接受远端胰腺切除术或胰十二指肠切除术的患者进行胰腺诊断使用主要的当前程序术语（CPT）代码。主要结果是NPWT和非NPWT患者组之间的手术部位感染率。次要结果包括脓毒症，感染性休克,重新接纳,再操作。使用多变量逻辑回归比较感兴趣的结果。结果54,457例患者接受了胰腺切除术，其中131例接受了NPWT。多变量分析，在考虑患者特征的同时，包括伤口分类，术后浅表SSI无差异，深SSI,脓毒症,感染性休克,或在NPWT和非NPWT组之间重新接纳。NPWT组的器官空间SSI较高(21%vs12%,p=0.001)。与手术相关的再手术在NPWT组中也很高（14％vs4.3％，p<0.001)。结论NPWT在远端胰腺切除术和胰十二指肠切除术中的使用与器官间隙SSIs增加和再次手术率相关。表面SSI没有差异，深SSI,或重新接纳。这项大样本研究表明，在胰腺切除术后使用NPWT切口伤口护理没有明显的好处。
