Effectiveness of Closed Incision Negative Pressure Wound Therapy for Suprainguinal Bypass in the Vascular Quality Initiative

Background

We sought to explore the utility of closed incision negative pressure wound therapy (ciNPWT) in prevention of groin wound complications after suprainguinal bypass using a national quality improvement database reflective of real-world practice.

Methods

The Vascular Quality Initiative was queried for suprainguinal bypass procedures from December 2019 to August 2023. Propensity matching was performed comparing ciNPWT versus standard dressings at (1) the index hospitalization (full cohort) and (2) 30 days (subgroup). The primary outcome was surgical site infection (SSI) at 30 days. Secondary outcomes included in-hospital SSI, return to operating room for infection, discharge disposition, length of stay and 30-day readmission rate, noninfectious wound complications, and mortality.

Results

The propensity-matched cohort consisted of 3,467 of a total of 5,082 patients undergoing suprainguinal bypass. Within the propensity-matched full cohort, 2,680 (77%) received standard dressing and 787 (23%) ciNPWT. Of those, 337 (61%) in the standard group and 150 (31%) in the ciNPWT group had 30-day follow-up data. There was a significant decrease in the rates of in-hospital SSI for those with ciNPWT at 2% compared to those with standard dressing at 4% (P = 0.02). There was no difference in 30-day SSI between groups with 3% in the ciNPWT group and 4% in the standard group (P = 0.40). After adjusting, there was no differences in 30-day readmission rates (P = 0.37), 30-day noninfectious wound complications (P = 0.28), 30-day mortality (P = 0.24), discharge disposition (P = 0.82), or length of stay (P = 0.23).

Conclusions

In this Vascular Quality Initiative analysis of suprainguinal bypass, we observed a decrease in the in-hospital SSI rate but no difference in the SSI or noninfectious wound complications at 30 days for patients treated with ciNPWT versus standard dressings. Given these findings, consideration should be given to conducting an adequately powered randomized control trial of ciNPWT targeted for suprainguinal bypass.