Bao Ngoc N Tran1, Anna Rose Johnson2, Changyu Shen2, Bernard T Lee2, Edward S Lee3. 1. Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey. 2. Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. 3. Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey. Electronic address: leee9@njms.rutgers.edu.
Abstract
BACKGROUND: Obesity is a known risk factor for surgical complications. Closed-incision negative-pressure therapy (ciNPT) has been used anecdotally in high-risk patients to prevent wound complications and infection. This meta-analysis aims to evaluate the efficacy of ciNPT in reducing the incidence of wound complications and infection in abdominal wall reconstruction. METHODS: A literature search using the PubMed/MEDLINE databases (2006-2016) was conducted to identify publications comparing ciNPT to standard incisional care for abdominal wall reconstruction. Outcomes of interest included surgical site infection, wound dehiscence, seroma, hematoma, reoperation, and readmission. Overall rates and associations were pooled. A fixed and random effects model was used upon meta-analysis. Publication bias was assessed using funnel plots. RESULTS: A total of 11 studies met inclusion criteria. There were 1723 patients included, 681 in the ciNPT group, and 1042 in the standard incisional care group. The majority of patients were obese, diabetic, and had a recent history of smoking. On meta-analysis, the risk of surgical site infection decreased by 51% (relative risk: 0.51, 95% confidence interval [0.41-0.63]). The risk of wound dehiscence decreased by 51% (relative risk: 0.51, 95% confidence interval [0.34-0.76]). There was no significant decreased risk observed with ciNPT use for the outcomes of seroma, hematoma, reoperation, and readmission. CONCLUSIONS: The use of ciNPT reduced the incidence of infection and wound dehiscence in patients with varying risk factors undergoing abdominal wall reconstruction. Future prospective randomized clinical trials are still needed to determine the efficacy of ciNPT in plastic surgery. Published by Elsevier Inc.
BACKGROUND: Obesity is a known risk factor for surgical complications. Closed-incision negative-pressure therapy (ciNPT) has been used anecdotally in high-risk patients to prevent wound complications and infection. This meta-analysis aims to evaluate the efficacy of ciNPT in reducing the incidence of wound complications and infection in abdominal wall reconstruction. METHODS: A literature search using the PubMed/MEDLINE databases (2006-2016) was conducted to identify publications comparing ciNPT to standard incisional care for abdominal wall reconstruction. Outcomes of interest included surgical site infection, wound dehiscence, seroma, hematoma, reoperation, and readmission. Overall rates and associations were pooled. A fixed and random effects model was used upon meta-analysis. Publication bias was assessed using funnel plots. RESULTS: A total of 11 studies met inclusion criteria. There were 1723 patients included, 681 in the ciNPT group, and 1042 in the standard incisional care group. The majority of patients were obese, diabetic, and had a recent history of smoking. On meta-analysis, the risk of surgical site infection decreased by 51% (relative risk: 0.51, 95% confidence interval [0.41-0.63]). The risk of wound dehiscence decreased by 51% (relative risk: 0.51, 95% confidence interval [0.34-0.76]). There was no significant decreased risk observed with ciNPT use for the outcomes of seroma, hematoma, reoperation, and readmission. CONCLUSIONS: The use of ciNPT reduced the incidence of infection and wound dehiscence in patients with varying risk factors undergoing abdominal wall reconstruction. Future prospective randomized clinical trials are still needed to determine the efficacy of ciNPT in plastic surgery. Published by Elsevier Inc.
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