A comparison of two single-use negative pressure wound therapy devices in the prevention of surgical site complications following Cardiovascular surgery, A retrospective real-world evidence analysis.

Introduction: Post-operative surgical site complications (SSCs) represent a significant burden to healthcare systems globally and pose many challenges for patients undergoing Cardiovascular procedure1-3. This study aimed 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 conducted using the Premier PINC AI Healthcare Database (PHD) between 2017 to June 2022.  PHD comprises hospital-based, service-level, all-payer information on inpatient discharges. 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 (CCI), 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 2552 patients were included for each device. 29% vs 38% were females, 22% vs 21% were smokers and 2.7% vs 2.6% used steroids, with a mean age of 66, CCI was 2.6 and 2.5 for Device 1 and Device 2 respectively.  57% of the procedures were CABG, 20% embolism and 17% heart valve. The incidence of dehiscence was 0.47% vs 1.14 p= 0.006, LOS 6.33 vs 6.86 days p 0.0001, Index admission cost- $32,701 vs $35,857 p 0.0001, 30-day costs $28,672 vs $32,121 p 0.0001 for Devices 1 and 2 respectively. No differences were observed for SSI 0.59% vs 0.67% p=0.58, superficial SSI 0.12% vs 0.24% p=0.22, deep SSI at 90 days 0.12 vs 0.16 p=0.65.Discussion: The use of sNPWT Device 1 reduced the incidence of dehiscence, LOS, and costs compared with Device 2 in following Cardiovascular procedures. This finding is important given the impact of a dehisced sternum on patients and resources. This difference may be explained by differences in the mechanism of action of the two devices.  References:1. Morrell Scott N, Lotto RR, Spencer E, et al. Risk factors for post sternotomy wound complications across the patient journey: A systematised review of the literature. Heart & Lung 2022;55:89-101. 2. Dell'Amore A, Congiu S, Campisi A, et al. Sternal reconstruction after post-sternotomy dehiscence and mediastinitis. Indian J Thorac Cardiovasc Surg 2020;36:388-396. 3. Choukari F. Management of sternotomy dehiscence revisited. Wounds UK 2020;16.