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Meta-Analysis
. 2021 Jan 8;5(1):zraa003.
doi: 10.1093/bjsopen/zraa003.

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

C Saunders  1 , L M Nherera  2 , A Horner  1 , P Trueman  2
Affiliations
Meta-Analysis

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

C Saunders et al. BJS Open. .

Abstract
in English, Spanish

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.

Antecedentes: Las complicaciones del sitio quirúrgico (surgical site complications, SSCs) siguen siendo una causa importante de morbilidad y mortalidad, especialmente en pacientes de alto riesgo. El objetivo de este estudio fue determinar si el uso profiláctico de un dispositivo específico de tratamiento de heridas con presión negativa de un solo uso (single-use negative pressure wound therapy, sNPWT) reducía la incidencia de SSCs después de incisiones quirúrgicas cerradas, en comparación con los apósitos convencionales.

Métodos: Se llevó a cabo una revisión sistemática de la literatura (systematic literature review, SLR) utilizando Medline, Embase y la Biblioteca Cochrane para identificar los artículos publicados entre enero de 2011 y agosto de 2018. Se seleccionaron ensayos clínicos aleatorizados y controlados (randomised controlled trials, RCTs) y estudios observacionales que comparaban PICO™ sNPWT con apósitos convencionales con al menos 10 pacientes incluidos en cada brazo de tratamiento. Se realizaron metaanálisis para determinar la razón de oportunidades (odds ratio, OR) o la diferencia de medias (mean difference, MD), según correspondiere. Se siguieron las recomendaciones PRISMA. El criterio de valoración principal fueron las infecciones del sitio quirúrgico (surgical site infections, SSIs). Los resultados secundarios eran otros CSS y las eficiencias hospitalarias. Se evaluó el riesgo de sesgo.

Resultados: De 6.197 referencias examinadas, se seleccionaron 29 estudios con 5.614 pacientes, todos los cuales presentaban factores de riesgo de SSCs. El sNPWT redujo las SSI (OR: 0,39; i.c. del 95%: 0,29-0,52; número necesario a tratar (NNT): 20). El sNPWT redujo las probabilidades de dehiscencia de la herida (OR: 0,70; i.c. del 95%: 0,53-0,92; NNT: 26), seroma (OR: 0,23; i.c. del 95%: 0,11-0,45; NNT: 13) y necrosis (OR: 0,11; i.c. del 95%: 0,03-0,39; NNT: 12). La duración media de la estancia hospitalaria fue más corta en los pacientes que se sometieron a sNPWT (diferencia media: -1,75; i.c. del 95%: -2,69 a -0,81).

Conclusión: El uso del dispositivo sNPWT en pacientes con factores de riesgo redujo la incidencia de SSCs y la duración media de la estancia hospitalaria.

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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.
See this image and copyright information in PMC

References

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