Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications

Abstract

Background: We report the first meta-analysis on the impact of prophylactic use of a specific design of negative pressure wound therapy (NPWT) device on surgical site complications.

Methods: Articles were identified in which the specific single-use NPWT device (PICO^⋄, Smith & Nephew) was compared with standard care for surgical site infection (SSI), dehiscence, or length of stay (LOS). Risk ratio (RR) ±95% confidence interval (CI) (SSI; dehiscence) or mean difference in LOS ±95% CI was calculated using RevMan v5.3.

Results: There were 1863 patients (2202 incisions) represented by 16 articles. Among 10 randomized studies, there was a significant reduction in SSI rate of 51% from 9.7% to 4.8% with NPWT intervention (RR 0.49 [95% CI 0.34-0.69] p < 0.0001). There were six observational studies assessing reduction in SSI rate of 67% from 22.5% to 7.4% with NPWT (RR 0. 32 [95% CI 0.18-0.55] p < 0.0001). Combining all 16 studies, there was a significant reduction in SSI of 58% from 12.5% to 5.2% with NPWT (RR 0.43 [95% CI 0.32-0.57] p < 0.0001). Similar effects were seen irrespective of the kind of surgery (orthopedic, abdominal, colorectal, or cesarean section), although the numbers needed to treat (NNT) were lower in operations with higher frequencies of complications. There was a significant reduction in dehiscence from 17.4% to 12.8% with NPWT (RR 0.71 [95% CI 0.54-0.92] p < 0.01). The mean reduction in hospital LOS by NPWT was also significant (-0.47 days [95% CI -0.71 to -0.23] p < 0.0001).

Conclusions: The significant reduction in SSI, wound dehiscence, and LOS on the basis of pooled data from 16 studies shows a benefit of the PICO single-use NPWT system compared with standard care in closed surgical incisions.

Keywords: postoperative complication; prophylaxis; surgical site infection; wound infection; wound management.

FIG. 1.

The PICO^⋄ single use negative pressure wound therapy in position on a patient with a cesarean section closed surgical incision. PICO (Smith & Nephew) is a small, lightweight, ultra-portable, negative pressure system that consists of a dressing, supplied with a small negative pressure pump powered by two AA batteries. The pump is disposable after seven days. The PICO system produces negative pressure at −80 mm Hg continuously, and therapy can be started or paused using the single orange button [53]. Used with permission from Bullogh and Burns [23].

FIG. 2.

The Preferred Reporting Items for Systematic reviews and Meta-Analyses flowchart showing selection of articles for the meta-analysis.

FIG. 3.

Forest plot of the comparison of PICO single-use negative pressure wound therapy compared with standard care on surgical site infection outcome by randomized controlled trial (RCT), observational, and overall. Random effects model risk ratio 0.45 (95% confidence interval 0.32–0.62) overall.

FIG. 4.

Forest plot of the comparison of PICO^⋄ single-use negative pressure wound therapy compared with standard care on dehiscence outcome. Random effects model RR 0.72 (95% CI 0.55–0.93).

FIG. 5.

Forest plot of the comparison of PICO^⋄ single-use negative pressure wound therapy compared with standard care on length of stay with subgroup analysis. Random effects model for all surgical procedures −2.15 (95% CI −3.46 to −0.84).

FIG. 6.

Funnel plot of comparison PICO^⋄ single-use negative pressure wound therapy compared with standard care on surgical site infection outcomes. SE = standard error; RR = risk ratio; RCT = randomized controlled trial.