A comparison of two single-use negative pressure wound therapy devices in the prevention of surgical site complications following Total Joint Arthroplasty, A retrospective claims database analysis.

Introduction: Total joint arthroplasty (TJA) can be associated with surgical site complications (SSCs), such as the development of surgical site infections (SSIs) and prolonged postoperative drainage, resulting in significantly increased length of stay (LOS) and healthcare costs1,2,3. 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, LOS, and index admission 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, there were 8884 patients included in each device, 66% were females, 8% were smokers and 3% used steroids in both groups.  57% and 60% of procedures were hips, 42% and 39% were knees and 1% were ankles. The mean age was 67, and CCI was 1.01 and 1.13 for Devices 1 and 2 respectively. The incidence of dehiscence was 0.07% vs 0.21 OR 0.36 p-value 0.014, LOS 2.43 vs 3.10, p 0.000, Index admission cost- $17,531 vs $22,461 p 0.0001, 30-day costs $17,467 vs $22,030 p 0.0001 in favor of Device 1. No statistical differences were observed for SSI 0.23% vs 0.32% p=0.24, superficial SSI 0.07% vs 0.12% p=0.45, deep SSI 0.01% vs 0.06% p=0.15.Discussion: Prophylactic use of the sNPWT Device 1 reduced the incidence of dehiscence, LOS, and costs compared with Device 2 following TJA. Therefore, this technology warrants policymakers' consideration to optimize postsurgical wound dehiscence and costs.References:1. Cooper HJ, Silverman RP, Collinsworth A, et al. Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies. Arthroplasty Today 2023;21. 2. Adeyemi A, Trueman P. Economic burden of surgical site infections within the episode of care following joint replacement. Journal of Orthopaedic Surgery and Research 2019;14:196. 3. Iannotti F, Prati P, Fidanza A, et al. Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients. Trop Med Infect Dis 2020;5(4):186.