Prophylactic Use of Negative Pressure Therapy in General Abdominal Surgery: A Systematic Review and Meta-Analysis

Abstract

Background: Surgical site infections (SSIs) represent an economic burden to healthcare systems. The use of negative pressure wound therapy (NPWT) for SSI prophylaxis remains uncertain. Methods: A systematic literature search was conducted in Medline/PubMed, CINAHL, and Web of Science for relevant studies. The primary outcome was the evaluation of the effectiveness of NPWT for prophylaxis of SSI rates in general abdominal surgery. Secondary outcomes were rates of seroma and wound dehiscence, length of hospital stay, and re-admission rates. The statistical analysis was performed with random effect models. Results: A total of 3,193 patients from 20 articles (six randomized controlled trials [RCT], three prospective, eight retrospective, and three ambispective studies) were analyzed. Negative pressure wound therapy was associated with decreased rate of SSIs compared with standard dressing in a pooled analysis of non-randomized studies and RCTs (0.57; 95% confidence interval [CI], -0.4 to 0.8; p < 0.001). This result, however, needs to be challenged because of a significant statistical heterogeneity of the included studies (I 2 = 71%; p < 0.01). A separate analysis of the six RCTs failed to confirm the superiority of NPWT (0.64; 95% CI, -0.4 to 1.04; p = 0.07), also disclosing significant heterogeneity. The analysis of secondary outcomes was only possible in combination of randomized and non-randomized studies because of incomplete datasets in RCTs. Re-admission rates were lower after NPWT and no difference was observed for the incidence of seroma, wound dehiscence, and length of hospital stay. Conclusions: Based on available evidence, the routine use of NPWT for SSI prophylaxis after laparotomy in general abdominal surgery cannot be generally recommended.

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update

“…Recent systematic reviews have demonstrated a significant reduction in SSI with their use. 217–219 These dressings have been particularly noted to reduce SSIs in patients who have undergone abdominal surgery 220,221 and joint arthroplasty, 222,223 although not all studies have shown benefit 224 and some indicate benefit only in a subset of procedures such as revision arthroplasty. 222 Guidance is lacking regarding which patients most benefit from the use of negative-pressure dressings, with some evidence that the benefit increases with age and body mass index.…”

“…These dressings have been particularly noted to reduce SSIs in patients who have undergone abdominal surgery 220,221 and joint arthroplasty, 222,223 although not all studies have shown benefit 224 and some indicate benefit only in a subset of procedures such as revision arthroplasty. 222…”

Negative Pressure Wound Therapy in Closed Colorectal Surgical Incisions: A Systematic Review and Meta-Analysis

“…Moreover, a separate metaanalysis with a significantly larger and broader sample size of 3193 patients concluded that a definitive recommendation on the prophylactic usage of NPWT for the prevention of SSI cannot be made. While a statistically significant association was found between a decrease in site infections and NPWT prophylactic usage, the findings were limited by high heterogeneity, potentially attributed to the inclusion of nonrandomized observational studies [23]. These conflicting results and the presence of high heterogeneity underscore the complexities of drawing definitive conclusions.…”

“…On the other hand, a previously mentioned meta-analysis conducted a comparative analysis of the rates of seroma in both the NPWT group and the standard dressing group and found no significant difference. However, in their analysis of seroma, three of the four studies were observational studies, which are considered inferior in terms of hierarchical research evidence compared to RCTs [23].…”