Closed Incisional Negative Pressure Therapy Reduces Perineal Wound Complications After Abdominoperineal Resection.

BACKGROUND: Perineal wound complications after abdominoperineal resection continue to be a significant challenge. Complications, ranging from 14% up to 60%, prolong hospitalization, increase risk of readmission and reoperation, delay the start of adjuvant therapy, and place psychological stress on the patient and family. OBJECTIVE: This study aimed to evaluate the impact of closed incision negative pressure therapy on perineal wound healing. DESIGN: This was a retrospective study. SETTINGS: The study was conducted in an academic community hospital. PATIENTS: Patients who underwent abdominoperineal resection from 2012 to 2020 were included. MAIN OUTCOME MEASURES: Perineal wound complications within 30 and 180 days were the primary outcome measures. RESULTS: A total of 45 patients were included in the study. Of these, 31 patients were managed with closed incision negative pressure therapy. The overall perineal wound complications were less frequent in the closed incision negative pressure therapy group (10/31; 32.2%) compared to the control group (10/14; 71.4%; = 5.99 [ p = 0.01]). In the closed incision negative pressure therapy group, 2 patients (20%) did not heal within 180 days and no patient required reoperation or readmission. In the control group, 4 patients (44%) had not healed at 180 days and 1 patient required flap reconstruction. When the effect of other variables was controlled, closed incision negative pressure therapy resulted in an 85% decrease in the odds of wound complications (adjusted OR 0.15 [95% CI, 0.03-0.60]; p = 0.01). LIMITATIONS: The nonrandomized nature and use of historical controls in this study are its limitations. CONCLUSIONS: The ease of application and the overall reduction in the incidence and severity of complications may offer an option for perineal wound management and possibly obviate the need for more expensive therapies. Further prospective controlled trials are required to effectively study its efficacy. See Video Abstract at http://links.lww.com/DCR/B895 . LA TERAPIA POR PRESIN NEGATIVA INCISIONAL CERRADA, REDUCE LAS COMPLICACIONES DE LA HERIDA PERINEAL DESPUS DE LA RESECCIN ABDOMINOPERINEAL: ANTECEDENTES:Las complicaciones de la herida perineal, después de la resección abdominoperineal, continúan siendo un desafío importante. Las complicaciones, que van desde el 14% hasta el 60%, prolongan la hospitalización, aumentan el riesgo de reingreso y reintervención, retrasan el inicio de la terapia adyuvante y generan estrés psicológico en el paciente y su familia.OBJETIVO:Evaluar el impacto de la terapia de presión negativa con incisión cerrada en la cicatrización de heridas perineales.DISEÑO:Estudio retrospectivo.ENTORNO CLINICO:Hospital comunitario académico.PACIENTES:Se incluyeron pacientes sometidos a resección abdominoperineal entre 2012 y 2020.PRINCIPALES MEDIDAS DE VALORACION:Las complicaciones de la herida perineal dentro de los 30 y 180 días fueron las principales medidas de valoración.RESULTADOS:Se incluyeron en el estudio a un total de 45 pacientes. De estos, 31 pacientes fueron tratados con terapia de presión negativa con incisión cerrada. Las complicaciones generales de la herida perineal fueron menos frecuentes en el grupo de terapia de presión negativa con incisión cerrada (10/31, 32,2%) en comparación con el grupo de control (10/14, 71,4%) (X_1 ^ 2 = 5,99 [ p = 0,01]). En el grupo de terapia de presión negativa con incisión cerrada, dos pacientes (20%) no cicatrizaron en 180 días y ningún paciente requirió reintervención o readmisión. En el grupo de control, cuatro pacientes (44%) no habían cicatrizado a los 180 días y un paciente requirió reconstrucción con colgajo. Cuando se controló el efecto de otras variables, la terapia de presión negativa con incisión cerrada resultó con una disminución del 85% en las probabilidades de complicaciones de la herida (OR ajustado, 0.15 [IC 95%, 0,03-0,60]; p = 0,01).LIMITACIONES:La naturaleza no aleatoria y el uso de controles históricos en este estudio, son limitaciones.CONCLUSIÓNES:La facilidad de aplicación, reducción general de la incidencia y gravedad de las complicaciones, pueden ofrecer una opción para el manejo de las heridas perineales y posiblemente obviar la necesidad de tratamientos más costosos. Se necesitan más ensayos controlados prospectivos para efectivamente estudiar la eficacia. Consulte Video Resumen en http://links.lww.com/DCR/B895 . (Traducción-Dr. Fidel Ruiz Healy ).

Delaware's inclusive trauma system: impact on mortality.

BACKGROUND: The impact of implementing an inclusive state trauma system on injury-related mortality for patients with life-threatening injuries was assessed. METHODS: Using the state trauma registry, trauma patients evaluated in all of Delaware's acute care hospitals from 1998 to 2007 were identified. Patients were categorized by injury severity score (ISS) groups (1-9, 10-15, 16-24, and >24). Each category was analyzed by mortality and interfacility transfer rate to the Level I trauma center for each year. An analysis of the National Trauma Data Bank (NTDB) for these ISS groups and mortality was performed to provide a comparative benchmark. Chi(2) and analysis of variance were used where appropriate (p 24 group. For this group, there was an incremental mortality decrease from 45.7% (1998) to 20.5% (2007) (p 24 group managed at the Level I hospital significantly increased over the same period. CONCLUSION: Since its inception, Delaware's trauma system, in which all acute care hospitals participate, has been associated with an incremental, significant decrease in mortality of the most critically injured patients. This decrease is more substantial than that experienced nationally as depicted within the NTDB. These findings and our evolving experience support the concept and benefits of an "inclusive" trauma system.

The Delaware trauma system: impact of Level III trauma centers.

BACKGROUND: In 2000, Delaware instituted a trauma system that included establishing four Level III trauma centers in counties previously without trauma centers. The purpose of this study was to analyze whether implementation of this inclusive trauma system reduced the injury-related mortality rates in these counties. METHODS: Using the state trauma registry, patients with trauma admitted to all acute care hospitals in Delaware from January 1, 1995 through December 31, 2004 were identified and categorized into two groups: preimplementation of an inclusive trauma system (1995-1999), and postimplementation (2000-2004). These groups were compared in aggregate and by individual counties for age, sex, mechanism of injury, Abbreviated Injury Score, injury-related mortality rate, mean Injury Severity Score (ISS), acute transfers out, and acute transfers in (Level I only). chi test and Mann-Whitney U test were used where indicated. Significance was determined to be p < or = 0.05. RESULTS: After implementation, mortality rates significantly decreased (5.3%-2.8%) and rate of acute transfers out increased (14.7%-19.5%) in the counties served by the Level III centers. The ISS of patients in the Level I trauma center significantly increased (mean ISS = 10) when compared with the Level III trauma centers (mean ISS = 6), reflecting increased transfers of patients with severe injuries. CONCLUSION: An inclusive state trauma system that included the establishment of Level III trauma centers in previously underserved counties led to a decrease in trauma-related mortality rates in these counties. In the county served by the Level I trauma center, mortality remained unchanged despite an increase in admissions and the injury severity of these admissions.