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. 2023 Apr 3:21:101120.
doi: 10.1016/j.artd.2023.101120. eCollection 2023 Jun.

Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies

H John Cooper  1 , Ronald P Silverman  2   3 , Ashley Collinsworth  2 , Christine Bongards  2 , Leah Griffin  2
Affiliations

Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies

H John Cooper et al. Arthroplast Today. .

Abstract

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgical procedures but carry a risk of harmful and costly surgical site complications (SSCs). This systematic review and meta-analysis examined the impact of closed incision negative pressure therapy (ciNPT) on the risk of SSCs following THA and TKA.

Methods: A systematic literature review identified studies published between January 2005 and July 2021 comparing ciNPT (Prevena Incision Management System) to traditional standard-of-care dressings for patients undergoing THA and TKA. Meta-analyses were performed using a random effects model. A cost analysis was conducted using inputs from the meta-analysis and cost estimates from a national database.

Results: Twelve studies met the inclusion criteria. Eight studies evaluated SSCs, where a significant difference was seen in favor of ciNPT (relative risk [RR]: 0.332, P < .001). Significant benefits in favor of ciNPT were also observed for surgical site infection (RR: 0.401, P = .016), seroma (RR: 0.473, P = .008), dehiscence (RR: 0.380, P = .014), prolonged incisional drainage (RR: 0.399, P = .003), and rate of return to the operating room (RR: 0.418, P = .001). The estimated cost savings attributed to ciNPT use was $932 per patient.

Conclusions: The use of ciNPT after TKA and THA was associated with a significant reduction in the risk of SSCs, including surgical site infections, seroma, dehiscence, and prolonged incisional drainage. The risk of reoperation was reduced as were the costs of care in the modeled cost analysis, suggesting a potential for both economic and clinical advantages for ciNPT over standard-of-care dressings, particularly in high-risk patients.

Keywords: Negative pressure wound therapy; Surgical site complication; Surgical site infection; Total hip arthroplasty; Total knee arthroplasty.

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Figures

Figure 1
Figure 1
Study population inclusion and exclusion criteria.
Figure 2
Figure 2
Forest plots of the effect of ciNPT on risk of (a) surgical site complication, (b) surgical site infection, (c) seroma, and (d) dehiscence for patients undergoing hip and knee arthroplasty.
Figure 3
Figure 3
Forest plots of the effect of ciNPT on risk of (a) incisional drainage, (b) hematoma, and (c) return to operating room for patients undergoing hip and knee arthroplasty.
Figure 4
Figure 4
Sub-group analyses: forest plots of the effect of ciNPT in high-risk cases on risk of (a) surgical site complication, (b) surgical site infection, and (c) surgical site complication in primary surgeries for patients undergoing hip and knee arthroplasty.
Figure 5
Figure 5
Sub-group analyses: forest plots of the effect of ciNPT vs silver dressings in high-risk cases on risk of (a) surgical site complication and (b) surgical site infection for patients undergoing hip and knee arthroplasty.
See this image and copyright information in PMC

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