412 Incisional Negative Pressure Wound Therapy Following Posterior Instrumented Spinal Fusion: A Single Surgeon’s Experience and Cost-Benefit Analysis

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INTRODUCTION: Surgical site infections (SSIs) following spine surgery are associated with significant morbidity and resource utilization. METHODS: We retrospectively reviewed all patients who received posterior instrumented spinal fusion by the senior author between July 2017 and December 2019 at a Level I trauma center. Statistical analysis was performed using Chi-square and Student’s t-tests. RESULTS: A total of 85 patients with standard surgical dressings and 144 patients with iNPWT were included for analysis. Patients in the iNPWT group were significantly older (61.8 vs. 58.5 years, p = 0.042) and more likely to be diabetic (36.8% vs. 23.5%, p = 0.037). Surgeries in the iNPWT group were associated with significantly greater blood loss (1298 mL vs. 998 mL, p = 0.036) and involved more instrumented levels (6.6 vs. 4.9, p < 0.0001). Prophylactic iNPWT use was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI requiring operative treatment (8.3% vs. 21.2%, p = 0.005). The incidence of wound dehiscence requiring operative wound revision was lower with iNPWT (14.6% vs. 24.7%, p = 0.056), though it did not reach statistical significance. Number needed to treat (NNT) with iNPWT to prevent one SSI was 7.79. The cost of preventing one operative SSI was $5,096. Cost-benefit analysis demonstrated a potential mean savings of $26,149 per operative SSI and $326,862 per 100 patients undergoing posterior instrumented spinal fusion with iNPWT. CONCLUSIONS: Prophylactic iNPWT use significantly reduced rates of wound dehiscence, SSI requiring operative treatment, and affords a potential SSI-related cost savings of $326,862 per 100 patients treated.