Pesonen LO, et al. – Authors here tested their hypothesis that prophylactic groin wound vacuum–assisted closure (VAC) therapy in enhanced risk patients would decrease surgical site infection (SSI) and readmission and the Wiseman model could provide potential evidence that enhanced risk patients could be objectively identified. In this study, the Wiseman scores indicated objective validation in the prognosis of anticipating groin wound breakdown. Their initial results suggested that prophylactic groin wound VAC placement for enhanced risk vascular surgery patients could proactively decrease wound morbidity, decrease readmission secondary to groin wound complications, and provide some cost benefit.

Methods

• Authors conducted a single institution, retrospective analysis from January 2013 to September 2016 utilizing procedure codes to identify patients with wound VACs placed in the operating room (OR).
• They identified two distinct groups.
• The first group was a wound complications patient group with 15 limbs (13 patients) with a groin wound VAC placed within 45 days postoperatively for groin wound complications.
• They placed VAC in eleven of these limbs at readmission.
• A prophylactic patient group was the second group, it included 8 limbs (7 patients) who received a VAC prophylactically placed in enhanced risk wounds.
• They determined these wounds to be enhanced risk based on clinical criteria judged by the operating surgeon such as a large overhanging panniculus and/or one of several ongoing medical issues.
• Calculation of a Wiseman score was performed for all patients.
• They determined total cost of the readmissions, and assessed 30 day postsurgical SSI incidence for the prophylactic VAC group.

Results

• The Wiseman scores indicated 9 limbs with postoperative complications at high risk and 3 limbs at moderate/ high risk.
• A VAC was placed in eleven limbs at readmission with an average readmission cost of $8,876.77.
• For the prophylactic group, 8 limbs were high risk with no observed postdischarge SSI in the first 30 days from surgery.
• In this study, the Wiseman scores suggested close correlation between the retrospective high and moderate/ high risk groups versus the prophylactic VAC group (31.5 +/– 7.3 vs 32 +/– 5.5, p=0.87).