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. 2022 Mar;3(3):189-195.
doi: 10.1302/2633-1462.33.BJO-2021-0199.R1.

Does negative pressure wound therapy reduce the odds of infection and improve health-related quality of life in patients with open fractures?

Yousif Atwan  1 , Sheila Sprague  2   3 , Gerard P Slobogean  4 , Sofia Bzovsky  3 , Kyle J Jeray  5 , Brad Petrisor  3 , Mohit Bhandari  2   3 , Emil Schemitsch  1 ; FLOW Investigators
Affiliations

Does negative pressure wound therapy reduce the odds of infection and improve health-related quality of life in patients with open fractures?

Yousif Atwan et al. Bone Jt Open. 2022 Mar.

Abstract

Aims: To evaluate the impact of negative pressure wound therapy (NPWT) on the odds of having deep infections and health-related quality of life (HRQoL) following open fractures.

Methods: Patients from the Fluid Lavage in Open Fracture Wounds (FLOW) trial with Gustilo-Anderson grade II or III open fractures within the lower limb were included in this secondary analysis. Using mixed effects logistic regression, we assessed the impact of NPWT on deep wound infection requiring surgical intervention within 12 months post-injury. Using multilevel model analyses, we evaluated the impact of NPWT on the Physical Component Summary (PCS) of the 12-Item Short-Form Health Survey (SF-12) at 12 months post-injury.

Results: After applying inverse probability treatment weighting to adjust for the influence of injury characteristics on type of dressing used, 1,322 participants were assessed. The odds of developing a deep infection requiring operative management within 12 months of initial surgery was 4.52-times higher in patients who received NPWT compared to those who received a standard wound dressing (95% confidence interval (CI) 1.84 to 11.12; p = 0.001). Overall, 1,040 participants were included in our HRQoL analysis, and those treated with NPWT had statistically significantly lower mean SF-12 PCS post-fracture (p < 0.001). These differences did not reach the minimally important difference for the SF-12 PCS.

Conclusion: Our analysis found that patients treated with NPWT had higher odds of developing a deep infection requiring operative management within 12 months post-fracture. Due to possible residual confounding with the worst cases being treated with NPWT, we are unable to determine if NPWT has a negative effect or is simply a marker of worse injuries or poor access to early soft-tissue coverage. Regardless, our results suggest that the use of this treatment requires further evaluation. Cite this article: Bone Jt Open 2022;3(3):189-195.

Keywords: Fractures; Infection; Negative Pressure Wound Therapy; SF-12 scores; Short Form Health Survey; deep infections; infection; logistic regression analysis; negative pressure wound therapy; open fractures; physical component summary (PCS); soft-tissue; wounds.

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Conflict of interest statement

ICMJE COI statement: S. Sprague reports board or committee member for Orthopaedic Trauma Association, employment from Global Research Solutions, and consultant fees from the University of Sherbrooke and Platform Life Sciences, all outside the submitted work. G. P. Slobogean reports editorial or governing board for the Journal of Orthopaedic Trauma, board or committee member for the Orthopaedic Trauma Association, paid consultant for Smith & Nephew, and paid consultant for Zimmer, all outside the submitted work. K. J. Jeray reports board or committee member for the American Board of Orthopaedic Surgery, board or committee member for the American Orthopaedic Association, editorial or governing board for the International Journal of Orthopedic Trauma, editorial or governing board for the Journal of Bone and Joint Surgery – American, editorial or governing board for the Journal of Orthopaedic Trauma, editorial or governing board for the Journal of the American Academy of Orthopaedic Surgeons, board or committee member for the Orthopaedic Trauma Association, paid presenter or speaker for Radius, board or committee member for the Southeastern Fracture Consortium, and paid consultant for Zimmer, all outside the submitted work. B. Petrisor reports paid consultant, paid presenter or speaker, and research support from Stryker and other financial or material support from Pfizer, all outside the submitted work. Dr. Bhandari reports paid consultant from AgNovos Healthcare, research support from the Canadian Institutes of Health Research (CIHR), board or committee member for the International Society of Orthopaedic Surgery and Traumatology (SICOT), research support from the National Institutes of Health (NIAMS & NICHD), research support from Physicians' Services Incorporated, paid consultant for Sanofi-Aventis, paid consultant for Smith & Nephew, and research support from the U.S. Department of Defense, all outside the submitted work. E. Schemitsch reports paid consultant for Acumed, paid consultant for Amgen, research support for Biocomposites, board or committee member for the Canadian Orthopaedic Association, other financial or material support for DePuy, paid consultant for Heron Therapeutics, IP royalties and paid consultant for ITS, editorial or governing board for the Journal of Orthopaedic Trauma, board or committee member for the Orthopaedic Trauma Association, editorial or governing board for Orthopaedic Trauma Association International, paid consultant for Pentopharm, paid consultant for Sanofi-Aventis, publishing royalties and financial or material support for Saunders/Mosby-Elsevier, other financial or material support, paid consultant, and research support for Smith & Nephew, publishing royalties and financial or material support for Springer, IP royalties, other financial or material support, and paid consultant for Stryker, paid consultant for Swemac, paid consultant for Synthes, and other financial or material support for Zimmer, all outside the submitted work. All other authors have nothing to report.

Figures

Fig. 1
Fig. 1
Covariate balance across comparison groups before and after propensity score weighting.
See this image and copyright information in PMC

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