Closed‐incision negative pressure therapy at −125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta‐analysis of randomized controlled trials

Abstract

Background Closed‐incision negative pressure wound therapy (ciNPT) has shown promising effects for managing infected wounds. This meta‐analysis explores the current state of knowledge on ciNPT in orthopedics and addresses whether ciNPT at −125 mmHg or −80 mmHg or conventional dressing reduces the incidence of surgical site complications in hip and knee arthroplasty. Methods This meta‐analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta‐analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non‐stratified and stratified meta‐analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant. Results The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (−125 mmHg) (63.1%) and PICO dressing (−80 mmHg) (36.8%). The non‐stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta‐analysis indicated that patients undergoing treatment with high‐pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low‐pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005). Conclusion When compared to conventional wound dressing and −80 mmHg ciNPT, the use of −125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.

A systemic review and a meta‐analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings

“…Similarly, more studies are needed to deliver a clinically meaningful difference in the results. This was recommended also in preceding similar meta‐analysis studies which showed a similar influence of NPWT and conventional dressings in subjects with different types of OTS 30,45‐53 . Well‐conducted studies are also needed to evaluate these factors and the mixture of different ages, and ethnicity; since our meta‐analysis study could not answer whether they are linked to the results.…”

“…This was recommended also in preceding similar meta‐analysis studies which showed a similar influence of NPWT and conventional dressings in subjects with different types of OTS. 30 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 Well‐conducted studies are also needed to evaluate these factors and the mixture of different ages, and ethnicity; since our meta‐analysis study could not answer whether they are linked to the results. We suggest that well‐designed, high‐quality RCTs are needed to evaluate the effect of NPWT on closed incisions in OTS.…”

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

“…For instance, two recent meta-analyses observed differences in rates of SSIs, complications, and drainage for patients who received −125 mm Hg ciNPT versus traditional dressings compared to patients who received −80 mm Hg ciNPT versus traditional dressings. 9,10 However, clinical studies that specifically compare these two systems are lacking, 10 and there may have been underlying differences in patient and wound comorbidities, surgical procedures, and study protocols that were not controlled for and may have biased observed outcomes.…”

The impact of negative pressure wound therapy on surgical wound infection, hospital stay and postoperative complications after spinal surgery: A meta‐analysis

“…10 There is a large body of evidence supporting a significant reduction in surgical wound problems with the use of NPWT, compared with conventional dressings, in both clean and contaminated wounds. 11,12 As a result, NPWT is increasingly being used as a prophylactic treatment to prevent surgical site wound infection complications of closed incisions. 13 NPWT is considered superior to standard dressings in cardiothoracic, general, vascular, obstetric and orthopaedic surgeries.…”