Jonah Shiroky1, Erin Lillie2, Hala Muaddi3, Marika Sevigny3, Woo Jin Choi3, Paul J Karanicolas4. 1. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada. 2. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada. 3. Division of General Surgery, Department of Surgery, University of Toronto, Canada. 4. Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada; Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of General Surgery, Department of Surgery, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada. Electronic address: Paul.Karanicolas@sunnybrook.ca.
Abstract
BACKGROUND: Surgical site infections cause substantial morbidity and mortality. Negative pressure wound therapy may reduce the risk of surgical site infections, but current evidence is unclear. The objective of this study was to examine whether negative pressure wound therapy reduces the risk of surgical site infections and other wound complications when compared with conventional dressings in all patients with primarily closed surgical wounds. METHODS: A comprehensive systematic review of randomized controlled trials was conducted. Trials that compared a negative pressure wound therapy system to any non-negative pressure wound therapy dressing in surgical wound(s) intended to heal by primary intention were eligible. Surgical site infection was the primary outcome, and secondary outcomes included wound dehiscence, pain, seroma, healing time, length of stay, device-related complications, cost-effectiveness, and quality of life. Selection, extraction, and risk of bias steps were done in duplicate, and data were synthesized using random effects meta-analyses. A priori sensitivity and subgroup analyses of the primary outcome were completed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to appraise the quality of the evidence. RESULTS: Forty-four randomized controlled trials with N = 5,693 patients were included. Patients treated with negative pressure wound therapy experienced nearly a 40% reduction in the risk of surgical site infections relative to those with conventional dressings, which was statistically significant: pooled risk ratio 0.61, 95% confidence interval 0.49-0.74, I2 = 26%. The effect remained consistent across surgical specialties and brands of negative pressure wound therapy devices. A statistically significant reduction in wound dehiscence and seroma incidence was also observed. CONCLUSION: There is moderate certainty that negative pressure wound therapy applied to closed surgical incisions reduces the risk of surgical site infections across all surgical procedures.
BACKGROUND: Surgical site infections cause substantial morbidity and mortality. Negative pressure wound therapy may reduce the risk of surgical site infections, but current evidence is unclear. The objective of this study was to examine whether negative pressure wound therapy reduces the risk of surgical site infections and other wound complications when compared with conventional dressings in all patients with primarily closed surgical wounds. METHODS: A comprehensive systematic review of randomized controlled trials was conducted. Trials that compared a negative pressure wound therapy system to any non-negative pressure wound therapy dressing in surgical wound(s) intended to heal by primary intention were eligible. Surgical site infection was the primary outcome, and secondary outcomes included wound dehiscence, pain, seroma, healing time, length of stay, device-related complications, cost-effectiveness, and quality of life. Selection, extraction, and risk of bias steps were done in duplicate, and data were synthesized using random effects meta-analyses. A priori sensitivity and subgroup analyses of the primary outcome were completed. The Grading of Recommendations, Assessment, Development, and Evaluations framework was used to appraise the quality of the evidence. RESULTS: Forty-four randomized controlled trials with N = 5,693 patients were included. Patients treated with negative pressure wound therapy experienced nearly a 40% reduction in the risk of surgical site infections relative to those with conventional dressings, which was statistically significant: pooled risk ratio 0.61, 95% confidence interval 0.49-0.74, I2 = 26%. The effect remained consistent across surgical specialties and brands of negative pressure wound therapy devices. A statistically significant reduction in wound dehiscence and seroma incidence was also observed. CONCLUSION: There is moderate certainty that negative pressure wound therapy applied to closed surgical incisions reduces the risk of surgical site infections across all surgical procedures.
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