Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Abstract

Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery.Methods: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool.Results: Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0⋅35, 95 per cent c.i. 0⋅24 to 0⋅50; P < 0⋅001). The heterogeneity between the included studies was low (I 2 = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0⋅37, 0⋅22 to 0⋅63; P < 0⋅001; I 2 = 0 per cent).Conclusion: Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.

A systematic review and meta-analysis of randomized controlled trials for the reduction of surgical site infection in closed incision management versus standard of care dressings over closed vascular groin incisions

“…Despite the discrepancies, the Svensson-Bj€ ork meta-analysis indicated that use of incision negative pressure wound therapy after groin incision in vascular surgery reduced the incidence of SSI compared to traditional postoperative dressings. 20 This finding is similar to our own.…”

“…11 While assessing the original raw data of the Gombert study, the high risk of bias as reported by Svensson-Björk et al. 20 could not be confirmed. Despite the discrepancies, the Svensson-Björk meta-analysis indicated that use of incision negative pressure wound therapy after groin incision in vascular surgery reduced the incidence of SSI compared to traditional postoperative dressings.…”

“…Recently, a meta-analysis examining the use of negative pressure therapy over vascular incisions has been published. 20 While our analysis focused on one specific device, the published study included therapy units from two different manufacturers, potentially leading to a lack of homogeneity in the interventional group. Although the same tools have been used to assess the risk of bias, different risk bias findings have been reported.…”

“…Although the same tools have been used to assess the risk of bias, different risk bias findings have been reported. Unfortunately, based on the available information and data, the reason for these differences was not determinable, especially the risk of bias for the study of Gombert et al 11 While assessing the original raw data of the Gombert study, the high risk of bias as reported by Svensson-Bj€ ork et al 20 could not be confirmed. Despite the discrepancies, the Svensson-Bj€ ork meta-analysis indicated that use of incision negative pressure wound therapy after groin incision in vascular surgery reduced the incidence of SSI compared to traditional postoperative dressings.…”

Incisional Negative Pressure Wound Therapy with Reinforcement of Subcutaneous Drainage (Hybrid-iNPWT)

“…We chose to use iNPWT for the management of these two challenging cases of degloving injuries. Several meta-analyses have shown efficacy in the prevention of wound dehiscence in high-risk cases [24][25][26][27][28][29][30][31][32][33] . We decided that the benefit obtained with use of iNPWT exceeded the cost of treatment, considering the cost of social welfare that would be incurred if these elderly patients were unable to walk.…”