Article
Therapy of complicated spinal wounds with negative pressure wound therapy in consideration of microbiological results – an analysis of 367 procedures
Therapie komplexer spinaler Wunden mit Vakuum-Therapie unter besonderer Berücksichtigung der mikrobiologischen Befunde – eine Analyse von 367 Operationen
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Authors
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Julia Kellner
- Georg August Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Bawarjan Schatlo
- Georg August Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Ingo Fiss
- Georg August Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Veit Rohde
- Georg August Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
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Simone Scheithauer
- Georg August Universität, Krankenhaushygiene und Infektiologie, Göttingen, Deutschland
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Christian von der Brelie
- Georg August Universität Göttingen, Neurochirurgie, Göttingen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: The incidence of complications after spinal surgery has significantly increased. Negative pressure wound therapy (NPWT) is an alternative tool to treat wound breakdown but systematic studies are lacking. The aim of this study is to analyse the clinical course of NPWT in 367 procedures. Risk factors of therapy should be evaluated as well as the success of NPWT in the treatment of wound infection with multi-drug resistant organisms (MDRO).
Methods: This is a retrospective observational analysis. All patients who underwent NPWT from 2006 to 2017 were included, opening of the dura during the primary surgery was not an exclusion criteria for NPWT. Analysed data included analysis of the initial surgery, duration of NPWT, surgical data, germ spectrum (including MDRO and changes of organisms during the course), antibiograms and antibiotic treatment. Outcome was analysed categorizing therapy success, length of hospital stay and number of repetitive NPWT. An analysis of the estimated costs was performed.
Results: Overall, 260 surgical wound revisions after primary spinal surgery and 367 NPWT procedures were analysed (82 patients, 37 male). Mean interval from primary surgery to wound breakdown was 14.6 days. Multilevel spinal instrumentation due to degenerative spine disease was the main reason for wound breakdown (41%; spondylodiscitis 29%, spinal tumours 16%). Mean number of NPWTs was 4. MDRO were found in 29.3% of the patients. In such cases initial calculated antibiotic treatment was appropriate only in 26.83%. Wound healing was achieved in 93.9% (mortality was 6.1%). Median hospital stay was 63 days (including initial surgery). A change of germ spectrum during the course was the only factor being associated with a longer hospital stay and number of NPWT. Wound closure was successful in 60% of all cases despite persistent microbiological infection. The mean rental fee for NPWT was 1033.05 €/patient and mean antibiotic therapy mean costs were 3628.70 €/patient.
Conclusion: This is the largest series of the results of NPWT in spine surgery. NPWT is a successful alternative to treat complex spinal wound breakdown even though there is a considerable mortality. NPWT was successful in curing wound infection with MRDO. Clinical assessment turned out to be a successful factor for indication of secondary wound closure. Treatment of spinal wound breakdown with NPWT results in significant costs.
