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Background <p>This retrospective observational single-center cohort study evaluated real-world outcomes of prophylactic closed-incision negative pressure wound therapy (ciNPWT) in high-risk spine surgery patients and explored the distribution of surgical site infection (SSI) across cumulative risk burden (RiskN) strata within this selectively treated cohort.</p> Methods <p>We reviewed consecutive spine surgery patients who received prophylactic single-use PICO 7 (Smith &amp; Nephew) ciNPWT immediately after wound closure between April 2023 and October 2025. High-risk status was defined according to Japanese reimbursable criteria. Cumulative risk burden was quantified as RiskN (1, 2, or ≥ 3). SSI was defined based on CDC criteria and reported with Wilson 95% confidence intervals (CIs).</p> Results <p>A total of 104 patients were analyzed (mean age 70.2 ± 12.7 years; BMI 24.1 ± 4.5&#xa0;kg/m²). The mean RiskN was 1.50 ± 0.78 (RiskN 1: 68 patients; RiskN 2: 22; RiskN 3–4: 14). The most frequent risk factor was hypoalbuminemia (57/104, 54.8%). Overall SSI occurred in 4 of 104 patients (3.8%; 95% CI, 1.5–9.5%). SSI rates were 2.9% (2/68) in RiskN 1, 0% (0/22) in RiskN 2, and 14.3% (2/14) in RiskN ≥ 3. Surgical procedures were mainly lumbar posterior (56/104, 53.8%) and thoracolumbar posterior (21/104, 20.2%); SSIs occurred after thoracolumbar posterior surgery (2/21), cervical posterior surgery (1/14), and lumbar posterior surgery (1/56). The most commonly used dressing size was 15 × 15&#xa0;cm (51/104, 49.0%).</p> Conclusions <p>In this selectively treated, reimbursement-linked high-risk spine surgery cohort managed with prophylactic ciNPWT, SSI was uncommon overall but remained observed in patients with higher cumulative risk burden. RiskN was used to contextualize residual SSI risk within this pragmatically treated population. The observed SSI rate should be interpreted as a residual (“breakthrough”) infection rate within a high-risk population. As a descriptive study without a control group, this study does not directly demonstrate the treatment effect of ciNPWT. Further comparative studies are needed to determine its incremental benefit, cost-effectiveness, and appropriate indications.</p>

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Risk stratification of surgical site infection in high-risk spine surgery under prophylactic ciNPWT

  • 期刊论文

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  • 发表日期：

    2026年4月11日

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  • Akihiko Hiyama,
  • Daisuke Sakai,
  • Nobuaki Hattori,
  • Masahiko Watanabe

摘要

Background

This retrospective observational single-center cohort study evaluated real-world outcomes of prophylactic closed-incision negative pressure wound therapy (ciNPWT) in high-risk spine surgery patients and explored the distribution of surgical site infection (SSI) across cumulative risk burden (RiskN) strata within this selectively treated cohort.

Methods

We reviewed consecutive spine surgery patients who received prophylactic single-use PICO 7 (Smith & Nephew) ciNPWT immediately after wound closure between April 2023 and October 2025. High-risk status was defined according to Japanese reimbursable criteria. Cumulative risk burden was quantified as RiskN (1, 2, or ≥ 3). SSI was defined based on CDC criteria and reported with Wilson 95% confidence intervals (CIs).

Results

A total of 104 patients were analyzed (mean age 70.2 ± 12.7 years; BMI 24.1 ± 4.5 kg/m²). The mean RiskN was 1.50 ± 0.78 (RiskN 1: 68 patients; RiskN 2: 22; RiskN 3–4: 14). The most frequent risk factor was hypoalbuminemia (57/104, 54.8%). Overall SSI occurred in 4 of 104 patients (3.8%; 95% CI, 1.5–9.5%). SSI rates were 2.9% (2/68) in RiskN 1, 0% (0/22) in RiskN 2, and 14.3% (2/14) in RiskN ≥ 3. Surgical procedures were mainly lumbar posterior (56/104, 53.8%) and thoracolumbar posterior (21/104, 20.2%); SSIs occurred after thoracolumbar posterior surgery (2/21), cervical posterior surgery (1/14), and lumbar posterior surgery (1/56). The most commonly used dressing size was 15 × 15 cm (51/104, 49.0%).

Conclusions

In this selectively treated, reimbursement-linked high-risk spine surgery cohort managed with prophylactic ciNPWT, SSI was uncommon overall but remained observed in patients with higher cumulative risk burden. RiskN was used to contextualize residual SSI risk within this pragmatically treated population. The observed SSI rate should be interpreted as a residual (“breakthrough”) infection rate within a high-risk population. As a descriptive study without a control group, this study does not directly demonstrate the treatment effect of ciNPWT. Further comparative studies are needed to determine its incremental benefit, cost-effectiveness, and appropriate indications.