Closed Incision Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections in Abdominal Surgery (CISSI)

Closed Incision Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections in Abdominal Surgery

Closed Incision Negative Pressure Wound Therapy for the Prevention of Surgical Site Infections in Abdominal Surgery - A Multicenter Randomized Controlled Trial

Surgical site infections (SSI) are a frequent complication in abdominal surgery. SSI lead to worse outcomes for the affected patients and significantly higher healthcare costs. Closed incision negative pressure wound therapy (ciNPWT) consists of a non-invasive, vacuum-assisted system that applies negative pressure to closed surgical incisions. It is currently unclear, if ciNPWT reduces SSI in patients undergoing abdominal surgery. This trial will investigate the effect of ciNPWT on SSI in abdominal surgery.

Background: Surgical site infections (SSI) are a frequent complication after abdominal surgery and are associated with increased morbidity and mortality, longer hospital stay, and significantly increased healthcare costs. Closed incision negative pressure wound therapy (ciNPWT) is a non-invasive, vacuum-assisted system that applies negative pressure to closed surgical incisions. Recent meta-analyses suggest that ciNPWT reduces the risk of SSI in abdominal surgery. However, based on the available randomized controlled trials (RCT), the evidence for the effect of ciNPWT on SSI in abdominal surgery is insufficient. Rationale: Considering the frequent occurrence of SSI in abdominal surgery, associated worse outcomes, and insufficient evidence, an adequately powered, robust RCT investigating the effect of ciNPWT on SSI in elective and emergency abdominal surgery is warranted. Provided that ciNPWT significantly reduces the incidence of SSI, this adjunct to surgical therapy has the potential to fundamentally improve patient outcomes in abdominal surgery. Aim of the trial: To investigate the effect of ciNPWT on superficial and deep SSI in patients undergoing elective or emergency abdominal surgery by laparotomy. Methodology: Multicenter, open-label, two arm, parallel group RCT. Patients undergoing elective or emergency laparotomy will be enrolled. During surgery, participants will be randomized in a 1:1 ratio to the ciNPWT (treatment) or standard dressing (control) group. After the completion of abdominal surgery and standardized skin closure with staples, either ciNPWT or standard dry dressings will be applied. Other than the study procedure, participants in both groups will be treated the same according to the current standard of care at the participating centers. Data collection will be carried out during the subsequent hospital stay and at 30 (+/- 7) days postoperatively. Hypothesis: The investigators hypothesize that ciNPWT will significantly reduce the incidence of superficial and deep SSI in patients undergoing laparotomy.

At the completion of the surgical procedure, the skin will be closed with staples at a distance of two centimeters from each other. After skin closure, ciNPWT will be applied, using a commercially available device. The device will be left in place for 7 days.

At the completion of the surgical procedure, the skin will be closed with staples at a distance of two centimeters from each other. After skin closure, conventional dry dressings will be applied. Conventional dressings will be changed according to clinical practice in the participating study centers.

After the completion of abdominal surgery and standardised skin closure with staples, ciNPWT will be applied, using a commercially available device.

After the completion of abdominal surgery and standardised skin closure with staples, standard dressings will be applied.

Number of participants with a superficial or deep surgical site infections at 30 (+/- 7) days postoperatively.

Number of participants with a superficial or deep or organ space surgical site infections at 30 (+/- 7) days postoperatively.

Number of participants with a superficial surgical site infections at 30 (+/- 7) days postoperatively. Number of participants with a deep surgical site infections at 30 (+/- 7) days postoperatively. Number of participants with an organ space surgical site infections at 30 (+/- 7) days postoperatively.

Inclusion Criteria: Elective or emergency laparotomy, or laparoscopy converted to laparotomy, including surgery for complications after elective operations Incision length ≥ 10 cm Centers for Disease Control and Prevention (CDC) wound class 1 and 2 (clean, clean-contaminated) Abdominal closure with or without mesh implantation Primary abdominal closure or closure after open abdomen treatment Age over 18 years Written informed consent Exclusion Criteria: Age ≤ 18 years CDC wound class 4 (dirty/infected wound) Organ transplantation Sensitivity or allergy to silver