Single-use negative-pressure wound therapy versus conventional dressings for closed surgical incisions: systematic literature review and meta-analysis

C Saunders, L M Nherera, A Horner, P Trueman, C Saunders, L M Nherera, A Horner, P Trueman

Abstract

Background: Surgical-site complications (SSCs) remain a significant cause of morbidity and mortality, particularly in high-risk patients. The aim of this study was to determine whether prophylactic use of a specific single-use negative-pressure wound therapy (sNPWT) device reduced the incidence of SSCs after closed surgical incisions compared with conventional dressings.

Methods: A systematic literature review was performed using MEDLINE, Embase and the Cochrane Library to identify articles published from January 2011 to August 2018. RCTs and observational studies comparing PICO™ sNPWT with conventional dressings, with at least 10 patients in each treatment arm, were included. Meta-analyses were performed to determine odds ratios (ORs) or mean differences (MDs), as appropriate. PRISMA guidelines were followed. The primary outcome was surgical-site infection (SSI). Secondary outcomes were other SSCs and hospital efficiencies. Risk of bias was assessed.

Results: Of 6197 citations screened, 29 studies enrolling 5614 patients were included in the review; all studies included patients with risk factors for SSCs. sNPWT reduced the number of SSIs (OR 0.37, 95 per cent c.i. 0.28 to 0.50; number needed to treat (NNT) 20). sNPWT reduced the odds of wound dehiscence (OR 0.70, 0.53 to 0.92; NNT 26), seroma (OR 0.23, 0.11 to 0.45; NNT 13) and necrosis (OR 0.11, 0.03 to 0.39; NNT 12). Mean length of hospital stay was shorter in patients who underwent sNPWT (MD -1.75, 95 per cent c.i. -2.69 to -0.81).

Conclusion: Use of the sNPWT device in patients with risk factors reduced the incidence of SSCs and the mean length of hospital stay.

© The Author(s) 2021. Published by Oxford University Press on behalf of BJS society Ltd.

Figures

Fig. 1
Fig. 1
PRISMA diagram for the review NPWT, negative-pressure wound therapy.
Fig. 2
Fig. 2
Forest plots of surgical-site infection in patients treated with PICO™ versus standard care A Mantel–Haenszel fixed-effect model was used for meta-analysis. Odds ratios are shown with 95 per cent confidence intervals.
Fig. 3
Fig. 3
Funnel plot for surgical-site infection outcome to assess publication bias For each clinical study included in the meta-analysis, the reported odds ratio (OR) was plotted against the standard error (s.e.). The overall effect average is shown by the vertical line, and the diagonal lines represent the region in which 95 per cent of trials were expected to lie.

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Source: PubMed

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