Grand Rounds

Does Negative Pressure Wound Therapy Decrease Infection in Women with BMI ≥30 Post Cesarean?

BACKGROUND AND PURPOSE:

Obesity is a risk factor of wound infection
- 10% of obese women will have surgical site infection post-cesarean despite use of prophylactic antibiotics
Hyldig et al. (BJOG, 2018) evaluated the impact prophylactic incisional negative pressure wound therapy on surgical site infections rate in an obese population

Unblinded, multicentered randomized controlled trial (RCT)
Participants
- Obese women undergoing elective or emergency cesarean
- ≥18 years
- Prepregnancy BMI ≥30 kg/m2
- Informed consent obtained during pregnancy and patient excluded from study if delivered vaginally
Standard procedures for all participants
- Chlorhexidine–alcohol prep
- Transverse lower abdominal incision
- Single dose of intravenous cefuroxime (1.5 or 3.0 g according to local standard procedures)
- Choice of suture material or staples based on surgeon preference
Participants were randomized to receive
- Incisional negative pressure wound therapy
- Standard dressing after caesarean section
Primary outcome: Surgical site infection requiring antibiotic treatment within the first 30 days after surgery
Secondary outcomes included
- Wound exudate | Dehiscence | Health-related quality of life
Logistic regression used to adjust for the following confounders
- BMI (<35 and ≥35 kg/m2) | Age | Diabetes | Smoking | Blood loss | Rupture of membranes | Duration of procedure | Staples vs sutures

432 women in the negative pressure group | 444 women in the standard dressing group
Surgical site infection occurred significantly less often in the intervention group (P=0.007)
- Negative pressure: 4.6%
- Standard dressing: 9.2%
- Relative risk (RR) 0.50; 95% CI, 0.30–0.84
Number needed to treat: 22
After adjusting for potential risk factors, the effect remained statistically significant
Wound exudate was significantly less in the intervention group (P = 0.001)
- Negative pressure: 22.4%
- Standard dressing: 32.9%
- RR 0.69; 95% CI, 0.55–0.86
No differences detected for secondary outcomes, including dehiscence and quality of life between the two group

Incisional negative pressure wound therapy reduced the risk of surgical site infection in obese women receiving a cesarean section
- Absolute risk reduction of 4.6%
There was an absolute risk reduction of 10.3% for wound exudate in the negative pressure group

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