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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