The use of negative pressure wound therapy dressing in obese women undergoing caesarean section: a pilot study

Abstract

Background. Obese women undergoing caesarean section (CS) are at increased risk of surgical site infection (SSI). Negative pressure wound therapy (NPWT) is growing in use as a prophylactic approach to prevent wound complications such as SSI, yet there is little evidence regarding its benefits. The aim of this pilot study was to evaluate the feasibility of undertaking a randomised controlled trial using NPWT in obese women undergoing elective CS. Method. Obese women undergoing elective CS were recruited from the antenatal clinic in a metropolitan hospital in Queensland, Australia, between 2012 and 2013. Using parallel 1:1 randomisation, 18 of these women received the intervention following closure of their wound in operating room (NPWT, PICOTM dressing) and 17 women received standard care (Comfeel Plusressing). Pre-defined criteria used to assess feasibility included: recruitment (>75% participation), loss to follow-up (<10%), intervention fidelity (=95%), and interrater reliability (kappa =0.8). Ethics approval was granted by the hospital and university human research ethics committees. Results. Of the 55 women approached, 48 (87%) consented to participate, 35 (63.6%) were randomised and 33 (94%) women completed post-discharge follow-up. All women received the intended dressing with the exception of one (2.8%) who later crossed over during dressing change. A kappa score of 0.87 (p<.0001) for SSI (yes/no) and an intraclass correlation coefficient score of 0.95 (p<.0001) for type of SSI were achieved. Conclusion. As shown in this study, careful planning and study site selection is critical to the success of the overall study. The results indicate that women with newborns are willing to participate in trials involving interventions and short-term follow-up.