Prophylactic Negative Pressure Wound Therapy for Closed Laparotomy Incisions

Abstract

Objective: The aim of this study was to determine whether negative pressure wound therapy (NPWT) applied to primarily closed incisions decreases surgical site infections (SSIs) following open abdominal surgery. Background: SSIs are a common cause of morbidity following open abdominal surgery. Prophylactic NPWT has shown promise for SSI reduction. However, the results of randomized controlled trials (RCTs) conducted among patients undergoing laparotomy have been inconsistent. Methods: We performed a meta-analysis of English language RCTs comparing the use of prophylactic NPWT to standard dressings on primarily closed laparotomy incisions following open abdominal surgery. Medline, EMBASE, Cochrane Library, and CINAHL databases were searched from inception to December 31st, 2018, for relevant studies. A random-effects model was used for statistical analysis. Results: Five RCTs totaling 792 patients were included in our meta-analysis after application of our exclusion and inclusion criteria. There was no significant difference in the risk of SSIs identified among those patients who had NPWT compared to standard dressings; relative risk (RR) 0.56 (95% confidence interval 0.30–1.03, P = 0.064). There was significant statistical heterogeneity across studies (I 2 = 67.4%; P = 0.015). Conclusion: The adoption of NPWT for routine SSI prophylaxis following laparotomy is currently not supported and should be used primarily in the context of a clinical trial.

Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials

“…However, to date there has been a lack of consensus on the routine use of NPWT following for all laparotomies, not just focusing on emergency cases. A meta-analysis in 2018 noted a decrease in overall SSI rates in NPWT patients [34], but there was considerable heterogeneity in the type of studies included, with one major critique being the inclusion of a RCT which applied NPWT to open rather than closed incisions [35,36].…”

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

“…Lastly, Kuper et al [ 62 ] conducted another meta-analysis and found no difference in the outcome between iNPWT and SD — with high heterogeneity between patient groups.…”

The effect of closed-incision negative pressure wound therapy on clinical and ultrasonographic seroma formation and wound healing following forequarter amputation in large dogs - a randomized pilot trial

“…In a recent experimental study in pigs, incisional wounds with extensive dead space were created on the dorsum to study the effect of ciNPWT applied for seven days concurrently with aspiration drains, and the authors described a significant decrease in the seroma drainage (through the drains) in the treatment group compared to the control group (Suh et al, 2016). From another perspective, in the current human literature, an extensive variety in the duration to apply ciNPWT treatment has been reported, ranging from a few days till more than ten days with most performed four-day protocols (Li et al, 2017;O'Leary et al, 2017;Shen et al, 2017;Kuper et al, 2020). Furthermore, longer treatments also involve longer hospitalization time and higher costs, which may be a limitation to the extended use of ciNPWT in veterinary patients (Gaus et al, 2017).…”

“…Some authors claim prevention of surgical site infections by using ciNPWT (Fernandez et al, 2019;Tran et al, 2019). However, data are not consistent regarding this advantage (Masden et al, 2012;Shen et al, 2017;Kuper et al, 2020). Unfortunately, the studies mentioned above did never focus on reporting pain scores.…”