Negative pressure dressings and the impact on pain management on thoracic incisions in patients undergoing oesophagectomy: a pilot study.

BACKGROUND: Pain control is recognised as a crucial post-operative measure for patients undergoing oesophagectomy with a thoracotomy incision for oesophageal cancer, where ineffective breathing due to pain is directly correlated with increased morbidity. The analgesic benefits of negative pressure wound therapy (NPWT) appear to be a relatively new and emerging finding. This pilot study aims to investigate the effects of NPWT on post-operative pain control and determine the feasibility of a larger trial. METHOD: Ten consecutive patients undergoing oesophagectomy were prospectively enrolled to have a PREVENA Incision Management System placed over a closed thoracotomy wound. This dressing was changed at post-operative day 5 and removed after day 10. Post-operative morbidity was recorded and analgesia was prescribed by the Acute Pain Service who were blinded to the study aims. Analgesia requirements were recorded in oral morphine equivalents (OME) and compared to 30 patients that had previously undergone oesophagectomy via thoracotomy. RESULTS: One patient was withdrawn from the study and there was no significant differences in patient demographics. The study group had less average daily analgesia requirements and reduced overall reported pain. Patients in the study group were less likely to develop pneumonia (44% and 57%) and less likely to require re-operation for complications of their surgery (0% and 10%). CONCLUSION: This pilot study shows reduced post-operative analgesia requirements and reduced morbidity when using NPWT over a closed thoracotomy wound, and affirms the feasibility of a future randomized control trial.

Does Delay to Theater Lead to Increased Infection Rates in Hand Trauma? A Retrospective Cohort Study.

BACKGROUND: In an ideal health system, traumatic wounds would be surgically managed within 24 hours; however, resource constraints result in patients with open wounds commonly waiting much longer for surgery. Does this result in increased morbidity? This study compares infection rates over time for patients who received operative management of traumatic hand injuries. METHODS: A retrospective analysis was undertaken of patients admitted between July 2014 and June 2015 who presented within 24 hours of sustaining a hand injury and subsequently underwent operative repair. Patient and injury data were collected from arrival time at emergency departments across 3 Victorian metropolitan hospitals within the same network. Admission and outpatient follow-up of these patients was reviewed for signs of infection and treatment with antibiotics. RESULTS: Six hundred thirty-eight patients met inclusion criteria, 8 of the 429 patients treated within 24 hours of presentation developed an infection (1.86%) compared with 11 of the 209 patients treated after 24 hours of presentation (5.26%). Using Fisher's exact analysis, a statistically significant association was identified (P = 0.024). An odds ratio of 2.924 was calculated, with a number needed to harm of 26. When time was analyzed as a continuous variable using logistic regression, there was no statistical significance. CONCLUSION: This study shows some evidence that a timing may be important to reduce the rates of infection and raises the possibility that there may be a double peak for infection risk at the 6-hour and 24-hour marks. This gives a basis of potential further study.