Prophylactic Negative Pressure Wound Therapy Dressings for Neuromodulation: A Single Center Study
Amaad Sulahria DO, Scott Pritzlaff MD, FIPP, CIPS, Connie Chan; Michael Jung, MD, MBA
INTRO
•Surgical site infection (SSI) is an important consideration for neuromodulation implants with an incidence of SSI as high as 10%.1,2
•The Neurostimulation Appropriateness Consensus Committee (NACC) reports infection rates associated with spinal cord stimulators (SCS) are often higher than those reported with other implantable devices indicating a need for improved practices.2
•Other surgical fields have utilized innovative wound dressing techniques such as negative pressure wound therapy (NPWT) to decrease SSI.3 NPWT consists of a closed, sealed system that applies negative pressure to the wound surface.3
•Despite high levels of evidence supporting NPWT, including multiple randomized controlled trials and systematic reviews such as a Cochrane review, such dressings have not been used in neuromodulation.3
METHODS
•A single-use NPWT (sNPWT) system, PICO 7 (Smith+Nephew, Watford, UK), was used for neuromodulation implantation.
•The PICO 7 is a sealed wound dressing attached to a portable vacuum pump that extracts fluid from the wound. The sNPWT dressing was applied for 7 days over both the lead insertion sites and pulse generator incision in a dual or single dressing technique (Figure 1A and 1B).
•A retrospective review of all patients who had the system applied was conducted, and clinical outcomes including SSI were assessed.
•The SSI rate was compared to the pre-sNPWT baseline from the prior twenty consecutive neuromodulation patients, which was 15% at our institution.
•The Fisher’s Exact test was used to assess for statistical significance, and a significance level of 0.05 (α=0.05) was used.
RESULTS
•Twenty-six patients underwent use of the sNPWT system between July 2021 and July 2024.
•Of these 26 patients, the sNPWT was used in nineteen SCS implants, one SCS explant, three dorsal root ganglion stimulator (DRG-S) implants, two lumbar multifidus stimulation system, and one basivertebral nerve ablation.
•The median age, weight, height, and body mass index (BMI) were 69.3 years old, 84.1 kg, 169 cm, and 29.3, respectively, with 46.2% females.
•There were no major adverse events and the rate of SSI (0%) was less than that of the prior twenty non-sNPWT patients. This, however, did not reach statistical significance (p=0.0751) in the setting of small sample sizes.
Conclusion:
NPWT dressings are a feasible method that may help reduce SSI, though further study is needed. SCS is an expensive procedure (with procedure-related costs averaging $67,191).4 Provenzano et al reported that the estimated incremental annual healthcare expenditures of SCS systems complicated by SSI is $59,716 for initial implanted patients and $64,833 for replacement SCS implants.4 Strugala et al published a meta-analysis of 1863 patients showing a significant reduction in SSI rate by 58%, reduction in wound dehiscence rate by 26%, and decreased hospital length of stay (LOS) with sNPWT.5
