Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial.

Gunatilake, Ravindu P

Swamy, Geeta K

Brancazio, Leo R

Smrtka, Michael P

Thompson, Jennifer L

Gilner, Jennifer B

Gray, Beverly A

Heine, Robert Phillips

United States

2018-03-04T22:31:51Z

2018-03-04T22:31:51Z

2017-07

Background  Postcesarean wound morbidity is a costly complication of cesarean delivery for which preventative strategies remain understudied.Objective We compared surgical site occurrences (SSOs) in cesarean patients receiving closed-incision negative-pressure therapy (ciNPT) or standard-of-care (SOC) dressing.Study Design A single-center randomized controlled trial compared ciNPT (5-7 days) to SOC dressing (1-2 days) in obese women (body mass index [BMI] ≥ 35), undergoing cesarean delivery between 2012 and 2014. Participants were randomized 1:1 and monitored 42 ± 10 days postoperatively. The primary outcome SSOs included unanticipated local inflammation, wound infection, seroma, hematoma, dehiscence, and need for surgical or antibiotic intervention.Results Of the 92 randomized patients, 82 completed the study. ciNPT and SOC groups had similar baseline characteristics. Mean BMI was 46.5 ± 6.5 and no treatment-related serious adverse events. Compared with SOC, the ciNPT group had fewer SSOs (7/43 [16.3%] vs. 2/39 [5.1%], respectively;p = 0.16); significantly fewer participants with less incisional pain both at rest (39/46 [84.8%] vs. 20/46 [43.5%];p < 0.001) and with incisional pressure (42/46 [91.3%] vs. 25/46 [54.3%];p < 0.001); and a 30% decrease in total opioid use (79.1 vs. 55.9 mg morphine equivalents,p = 0.036).Conclusion A trend in SSO reduction and a statistically significant reduction in postoperative pain and narcotic use was observed in women using ciNPT.

https://www.ncbi.nlm.nih.gov/pubmed/28717587

170022

2157-6998

https://hdl.handle.net/10161/16163

eng

Georg Thieme Verlag KG

AJP Rep

10.1055/s-0037-1603956

cesarean

negative pressure wound therapy

obesity

wound infection

Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial.

Journal article

Swamy, Geeta K|0000-0001-5092-6993

Gilner, Jennifer B|0000-0002-8996-2972

Gray, Beverly A|0000-0002-2254-4127

https://www.ncbi.nlm.nih.gov/pubmed/28717587

e151

e157

3

Clinical Science Departments

Duke

Duke Human Vaccine Institute

Institutes and Centers

Midwifery Service

Obstetrics and Gynecology

Obstetrics and Gynecology, Duke Women's Health Associates

Obstetrics and Gynecology, Maternal Fetal Medicine

School of Medicine

Published

7