Abstract 60: Can Closed Incision Negative Pressure Therapy Impact Post Operative Outcomes in Breast Reconstruction?

Background/Objective: There is evidence that closed-incision management using negative-pressure therapy (ciNPT) may have clinical benefit in surgical applications including orthopedic, sternotomy, colorectal, and abdominal wall repairs by protecting surgical incisions, maintaining a closed environment and removing fluids and infectious materials. However, little evidence exists on the effect of ciNPT use after breast reconstruction procedures. Thus, the goal of this study was to compare post-operative outcomes among patients using ciNPT and standard of care (SOC) after breast reconstruction. Methods: This was a single site, retrospective cohort study that included data for patients undergoing breast reconstruction from October 1, 2013 to March 31, 2016. Variables collected included patient characteristics, co-morbidities, chemotherapy and radiation exposure, surgical technique, ciNPT (as delivered by PREVENA™ Therapy) use, and outcomes such as number of drains, drain duration, and complication rates within 90 days. Two-sided T-tests and Chi-square or Fisher's Exact tests were performed at α=0.05. General linear models and multiple logistic regression models were also performed for continuous and categorical outcomes, respectively, in order to control for possible confounding variables. Results: The study included data on 155 patients (ciNPT=117, SOC=91) and 294 breasts (ciNPT=125, SOC=169). There were no significant differences in age, BMI, proportion of smokers, and patients with hypertension between the groups. The ciNPT group had a significantly lower proportion of patients with diabetes (0% vs. 11%; p=0.0055) and prior breast surgery (17.7% vs. 38.5%; p=0.0061) compared to SOC. There was no difference in chemotherapy exposure between the groups; however, fewer ciNPT patients had radiation exposure compared to SOC (10.9% vs. 31.1%; p=0.0032). A higher proportion of ciNPT patients underwent the pre-pectoral technique of breast reconstruction (53.1% vs. 25.3%; p=0.0004) compared to SOC. The ciNPT group had lower rates of overall complications, infections, dehiscences, necroses, and returns to the operating room compared to SOC. All patients (100%) in the ciNPT grouphad 2 drains compared to 81.7% of the SOC group (p < 0.0001). Moreover, the ciNPT group had significantly lower mean drain days per-drain (6.1 vs. 9, p < 0.0001) and total drain days (12.2 vs. 18.1, p < 0.0001) compared to SOC group. Results of general linear models and logistic regression were similar to the univariate analyses after controlling for effects of age, BMI, surgical technique, diabetes, hypertension, and prior breast surgery. The ciNPT group had significantly lower total drain days (11.9 vs. 17.8 days; p < 0.0001) and lower proportion of breasts with any complication compared to SOC (odds ratio for No ciNPT use vs. ciNPT use = 2.983, 95% confidence interval = 1.043-8.532; p=0.0416). Conclusions: This study demonstrated significantly lower infection, dehiscence, necrosis rates, and drain duration among the ciNPT group. These results may translate to improved patient outcomes and efficient use of resources in a hospital setting. Further studies are needed to corroborate the findings in our study.