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Grand Rounds

Cochrane Review Update: Negative Pressure Wound Therapy and Infection Risk

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BACKGROUND AND PURPOSE:

  • Normal et al. (Cochrane Database Syst Rev., 2020) examined the effects of negative pressure wound therapy (NPWT) for preventing SSI in wounds healing through primary closure
  • This is the third update to this review and meta-analysis

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • Trials that randomly allocated participants to treatment and compared
      • NPWT to any other type of wound dressing
      • One type of NPWT to another type of NPWT
    • Economic studies were included if they calculated quality-adjusted life-years for treatment groups and produced estimates of the treatments’ relative cost-effectiveness
  • Study design and data analysis
    • Authors independently assessed trials using predetermined inclusion criteria
    • This review and meta-analysis was carried out using the GRADE criteria  

RESULTS:

  • 15 new RCTs and 3 new economic studies added to current study
  • Total of 44 RCTS (with 7447 included participants) | 5 economic studies
    • Included multiple surgical specialties such as orthopedic, obstetric, vascular, and general procedures
  • All the studies compared NPWT with standard wound dressing
  • Most studies had unclear or high risk of bias for at least one key domain

Mortality

  • 4 studies | 2107 participants
  • There was no difference in risk of death after surgery for people treated with NPWT compared with standard dressings
    • NPWT: 2.3%
    • Standard dressings: 2.7%
    • Risk ratio (RR) 0.86 (95% CI, 0.50 to 1.47)
    • Low-certainty evidence (downgraded twice for imprecision)

Surgical Site Infection Outcomes

  • 31 studies included in the meta-analysis | 6204 participants
  • NPWT probably results in fewer SSI than standard dressings after surgery (moderate certainty evidence)
    • NPWT: 8.8%
    • Standard dressings: 13.0%
    • RR 0.66 (95% CI, 0.55 to 0.80)

Dehiscence

  • 14 studies included in the meta-analysis | 3809 participants
  • There was no clear difference in the risk of dehiscence after surgery for NPWT compared with standard dressings (low-certainty evidence)
    • NPWT: 5.3%
    • Standard dressings: 6.2%
    • RR 0.88 (95% CI, 0.69 to 1.13)

Secondary Outcomes

  • There was no clear difference between NPWT and standard dressing for the following
    • Reoperation: RR 1.04 (95% CI, 0.78 to 1.41)
    • Seroma: RR 0.72 (95% CI, 0.50 to 1.05)
    • Hematoma: RR 0.67 (95% CI, 0.28 to 1.59)
    • Skin blisters: RR 2.64 (95% CI, 0.65 to 10.68)
  • Effect on pain is uncertain
  • There is probably little difference in the quality of life scores at 30 days or 3 months or 6 months after surgery in the following clinical settings (Moderate-certainty evidence)
    • Cesarean delivery (1 trial, 876 participants)
    • Lower limb fracture (1 trial, 1549 participants)

Cost-effectiveness

  • 5 economic studies included: Compared cost-effectiveness of NPWT vs standard dressings for four indications
    • Cesarean delivery in obese women: Probably cost-effective
    • Surgery for lower limb fracture: Probably not cost-effective
  • Other studies found evidence that NPWT may be cost-effective for the indications assessed, but evidence was low or very low-certainty

CONCLUSION:

  • Results from this third Cochrane update suggest that NPWT following surgery with primary wound closure vs standard dressings
    • Probably results in fewer SSIs
    • No clear difference in mortality or dehiscence
    • Probably little difference in quality of life scores for caesarean delivery in obese women and surgery for lower limb fracture
  • Cost-effectiveness
    • Use of NPWT may be cost-effective for cesarean delivery in obese women

Learn More – Primary Sources:

Negative Pressure Wound Therapy for Surgical Wounds Healing by Primary Closure

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Related ObG Topics:

Does Prophylactic Negative Pressure Wound Therapy Decrease Cesarean Section Infection in Obese Women?
Does Prophylactic Negative-Pressure Decrease Cesarean Section Wound Infections?
Is Incisional Negative Pressure Wound Therapy for Obesity-Related Cesarean Wound Infection Cost-Effective? 

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