A Multicenter, Prospective Randomized Trial of Negative Pressure Wound Therapy for Infrainguinal Revascularization Groin Incisions

Bertges, Daniel J.; Smith, Lisa; Scully, Rebecca E.; Wyers, Mark C.; Eldrup-Jorgenson, Jens; Suckow, Bjoern D.; Ozaki, C. Keith; Nguyen, Louis N.

doi:10.1016/j.jvs.2020.06.034

Cited by 6 publications

(23 citation statements)

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“…The included studies represent a global surgical patient population with 7451 patients receiving ciNPT and 16,085 patients receiving SOC across 16 countries. 11–16,20–97 The countries represented included the USA (n = 42), Germany (n = 11), Australia (n = 6), Canada (n = 5), Italy (n = 4), Spain (n = 3), the UK (n = 3), Denmark (n = 2), and one each from Austria, Brazil, France, Ireland, the Netherlands, South Africa, Taiwan, and Turkey. Dressings used in the SOC population varied and included gauze dressings, antimicrobial hydrofiber dressings, absorbent dressings, hydrocolloid dressings, occlusive dressings, or foam dressings.…”

Section: Resultsmentioning

confidence: 99%

“…The 84 studies identified encompassed cardiac surgery (n = 8), general abdominal surgery (n = 21), obstetric and gynecologic surgery (n = 8), orthopedic surgery (n = 16), plastic surgery (n = 16), and vascular surgery (n = 15). 11–16,20–97…”

Section: Resultsmentioning

confidence: 99%

“…Dressings used in the SOC population varied and included gauze dressings, antimicrobial hydrofiber dressings, absorbent dressings, hydrocolloid dressings, occlusive dressings, or foam dressings. 11–16,20–97…”

Section: Resultsmentioning

confidence: 99%

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Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

Cooper

Singh

Gabriel

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Surgical site complications (SSCs), such as surgical site infection (SSI), dehiscence, seroma, hematoma, and skin necrosis, are associated with increased patient morbidity and mortality. 1 Patients who develop SSCs often experience delayed wound healing, decreased quality of life, and increases in length of stay (LOS), medical procedures performed, pain, and potential reoperation and readmission. [1][2][3] Increased use of resources with management Reconstructive ORiginal aRticleIntroduction: Closed incision negative pressure therapy (ciNPT) has been utilized to help manage closed incisions across many surgical specialties. This systematic review and meta-analysis evaluated the effect of ciNPT on postsurgical and health economic outcomes. Methods: A systematic literature search using PubMed, EMBASE, and QUOSA was performed for publications written in English, comparing ciNPT to standard-of-care dressings between January 2005 and August 2021. Study participant characteristics, surgical procedure, dressings used, treatment duration, postsurgical outcomes, and follow-up data were extracted. Meta-analyses were performed using random-effects models. Risk ratios summarized dichotomous outcomes. Difference in means or standardized difference in means was used to assess continuous variables reported on the same scale or outcomes reported on different scales/measurement instruments. Results: The literature search identified 84 studies for analysis. Significant reductions in surgical site complication (SSC), surgical site infection (SSI), superficial SSI, deep SSI, seroma, dehiscence, skin necrosis, and prolonged incisional drainage were associated with ciNPT use (P < 0.05). Reduced readmissions and reoperations were significant in favor of ciNPT (P < 0.05). Patients receiving ciNPT had a 0.9-day shorter hospital stay (P < 0.0001). Differences in postoperative pain scores and reported amounts of opioid usage were significant in favor of ciNPT use (P < 0.05). Scar evaluations demonstrated improved scarring in favor of ciNPT (P < 0.05). Discussion: For these meta-analyses, ciNPT use was associated with statistically significant reduction in SSCs, SSIs, seroma, dehiscence, and skin necrosis incidence. Reduced readmissions, reoperation, length of hospital stay, decreased pain scores and opioid use, and improved scarring were also observed in ciNPT patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

Cooper

Singh

Gabriel

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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“…Characteristics of the 26 RCTs 25–50 and their included patients is summarized in the Table in Supplemental Digital Content 3, http://links.lww.com/SLA/E499. Their median publication date was 2010 (interquartile range=23; range=1981–2021).…”

Section: Resultsmentioning

confidence: 99%

“…Six studies had an unclear 30,39,41,44,46,48 risk of bias, and 9 studies had a high 26,28,29,31,33,36,38,40,47 risk of bias regarding allocation concealment. Researchers and participants were not blinded to treatment allocation in 12 studies 25,26,28–31,33,36–38,47,49 . In 5 studies, 39–41,44,48 it was unclear whether researchers and participants were blinded to treatment allocation.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery

et al. 2023

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Objective: The objective of this study is to evaluate the efficacy of strategies intended to prevent surgical site infection (SSI) after lower limb revascularization surgery. Background: SSIs are common, costly complications of lower limb revascularization surgery associated with significant morbidity and mortality. Methods: We searched MEDLINE, EMBASE, CENTRAL, and Evidence-Based Medicine Reviews (inception to April 28, 2022). Two investigators independently screened abstracts and full-text articles, extracted data, and assessed the risk of bias. We included randomized controlled trials (RCTs) that evaluated strategies intended to prevent SSI after lower limb revascularization surgery for peripheral artery disease. We used random-effects models to pool data and GRADE to assess certainty. Results: Among 6258 identified citations, we included 26 RCTs (n=4752 patients) that evaluated 12 strategies to prevent SSI. Preincision antibiotics [risk ratio (RR)=0.25; 95% CI, 0.11–0.57; n=4 studies; I 2 statistic=7.1%; high certainty] and incisional negative-pressure wound therapy (iNPWT) (RR=0.54; 95% CI, 0.38–0.78; n=5 studies; I 2 statistic=7.2%; high certainty) reduced pooled risk of early (≤30 days) SSI. iNPWT also reduced the risk of longer-term (>30 days) SSI (pooled-RR=0.44; 95% CI, 0.26–0.73; n=2 studies; I 2=0%; low certainty). Strategies with uncertain effects on risk of SSI included preincision ultrasound vein mapping (RR=0.58; 95% CI, 0.33–1.01; n=1 study); transverse groin incisions (RR=0.33; 95% CI, 0.097–1.15; n=1 study), antibiotic-bonded prosthetic bypass grafts (RR=0.74; 95% CI, 0.44–1.25; n=1 study; n=257 patients), and postoperative oxygen administration (RR=0.66; 95% CI, 0.42–1.03; n=1 study) (low certainty for all). Conclusions: Preincision antibiotics and iNPWT reduce the risk of early SSI after lower limb revascularization surgery. Confirmatory trials are required to determine whether other promising strategies also reduce SSI risk.

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Negative pressure wound therapy for surgical wounds healing by primary closure

Norman

Shi

Goh

et al. 2022

Cochrane Database of Systematic Reviews

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Background Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. Objectives To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost‐effectiveness of NPWT in wounds healing through primary closure. Search methods In January 2021, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In‐Process & Other Non‐Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. Selection criteria We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another. Data collection and analysis At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane risk of bias tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. Our primary outcomes were SSI, mortality, and wound dehiscence. Main results In this fourth update, we added 18 new randomised controlled trials (RCTs) and one new economic study, resulting in a total of 62 RCTs (13,340 included participants) and six economic studies. Studies evaluated NPWT in a wide range of surgeries, including orthopaedic, obstetric, vascular and general procedures. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Eleven studies (6384 participants) which reported mortality were pooled. There is low‐certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%) but there is uncertainty around this as confidence intervals include risk of benefits and harm; risk ratio (RR) 0.78 (95% CI 0.47 to 1.30; I 2 = 0%). Fifty‐four studies reported SSI; 44 studies (11,403 participants) were pooled. There is moderate‐certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery; RR 0.73 (95% CI 0.63 to 0.85; I 2 = 29%). Thirty studies reported wound dehiscence; 23 studies (8724 participants) were pooled. There is moderate‐certainty evidence that there is probably little or no differe...

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A Multicenter, Prospective Randomized Trial of Negative Pressure Wound Therapy for Infrainguinal Revascularization Groin Incisions

Cited by 6 publications

References 0 publications

Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

Efficacy of Strategies Intended to Prevent Surgical Site Infection After Lower Limb Revascularization Surgery

Negative pressure wound therapy for surgical wounds healing by primary closure

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