Risk Factors for Unsuccessful Treatment and Complications With Negative Pressure Wound Therapy
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Index: WOUNDS. 2012;24(6):168–177.
Abstract: The aim of this retrospective study was to identify risk factors related to unsuccessful treatment and complications with negative pressure wound therapy (NPWT). Methods. A consecutive series of patients treated with NPWT for wounds of various etiologies (n = 87) from 2005–2007 at a general hospital in a large city (Stockholm, Sweden) were assessed for risk for unsuccessful treatment and complications associated with NPWT. Results. Twenty-nine percent of the patients treated with NPWT had unsuccessful treatment results. The strongest risk factors associated with unsuccessful treatment were pressure ulcers (OR 4.6) or a positive culture for Staphylococci (OR 3.4).
The complication rate was 21%, of which 14 patients had to terminate treatment. A positive culture for either Staphylococci or Pseudomonas was strongly associated (P = 0.001) with risk of complications during NPWT treatment. Patients with insufficient peripheral circulation in the extremities had a risk of both unsuccessful treatment and complications. Conclusion. The findings of the present study stress the importance of evaluating bacterial cultures and adequate antibiotic therapy when infection is suspected. The status of the patient’s peripheral macrocirculation in the lower extremities seems to have a significant impact on the risk of unsuccessful treatment or complications. Therefore, is it of great importance to evaluate peripheral circulation status before initializing NPWT.
Modern wound care consists of many different dressing materials and techniques. Commercial negative pressure wound therapy (NPWT) has been used to treat wounds of varying etiology since 1995.1 The therapy has proven to be safe, and the treatment results are equal to other wound care methods.2,3 Nevertheless, in earlier studies, there are indications that NPWT results can vary among wound etiologies, and that patient related factors could have an impact on outcomes.4 Therefore, it is important to identify those patients who would likely benefit from the treatment, and more importantly, those patients who most likely would not.
Negative pressure wound therapy has become the gold standard for some diagnoses, such as open abdominal wounds5-7 and dehisced sternal wounds, following cardiac surgery.8,9 The effect of NPWT remains unclear for wounds of other etiologies, such as pressure ulcers, wounds of infectious origin, diabetic wounds, and traumatic wounds. Previous studies are questionable regarding their reliability and validity, due to problems related to sample size, methods of randomization, allocation concealment, and diverging results.2,3,10 Another problem is that the previous studies show a discrepancy in outcome measures and lack evaluation of the clinical importance of the different measure methods used.
Adverse events and risk factors with NPWT have not been the primary focus of most studies. A systematic review by Vikatmaa et al2 focusing on the effects and safety of NPWT, showed that infection, skin irritation, and pain during foam dressing changes, were adverse events associated with the treatment. The US Food and Drug Administration (FDA) received reports of 6 deaths and 77 injuries associated with NPWT during 2008–2009.11 Bleeding was the most serious complication and caused all 6 deaths and 17 injuries. Vascular grafts, sternal and groin wounds, anticoagulant therapy, and foam dressing removal were factors that increased the risk of bleeding complications.