Single-use negative-pressure wound therapy versus conventional dressings for closed surgical incisions: systematic literature review and meta-analysis.
patients with risk factors for surgical-site complications
prophylactic use of a specific single-use negative-pressure wound therapy (sNPWT) device
conventional dressings
surgical-site infection (SSI), wound dehiscence, seroma, necrosis, mean length of hospital stay
Abstract
Surgical-site complications (SSCs) remain a significant cause of morbidity and mortality, particularly in high-risk patients. The aim of this study was to determine whether prophylactic use of a specific single-use negative-pressure wound therapy (sNPWT) device reduced the incidence of SSCs after closed surgical incisions compared with conventional dressings. A systematic literature review was performed using MEDLINE, Embase and the Cochrane Library to identify articles published from January 2011 to August 2018. RCTs and observational studies comparing PICO™ sNPWT with conventional dressings, with at least 10 patients in each treatment arm, were included. Meta-analyses were performed to determine odds ratios (ORs) or mean differences (MDs), as appropriate. PRISMA guidelines were followed. The primary outcome was surgical-site infection (SSI). Secondary outcomes were other SSCs and hospital efficiencies. Risk of bias was assessed. Of 6197 citations screened, 29 studies enrolling 5614 patients were included in the review; all studies included patients with risk factors for SSCs. sNPWT reduced the number of SSIs (OR 0.37, 95 per cent c.i. 0.28 to 0.50; number needed to treat (NNT) 20). sNPWT reduced the odds of wound dehiscence (OR 0.70, 0.53 to 0.92; NNT 26), seroma (OR 0.23, 0.11 to 0.45; NNT 13) and necrosis (OR 0.11, 0.03 to 0.39; NNT 12). Mean length of hospital stay was shorter in patients who underwent sNPWT (MD -1.75, 95 per cent c.i. -2.69 to -0.81). Use of the sNPWT device in patients with risk factors reduced the incidence of SSCs and the mean length of hospital stay. Las complicaciones del sitio quirúrgico ( Se llevó a cabo una revisión sistemática de la literatura ( De 6.197 referencias examinadas, se seleccionaron 29 estudios con 5.614 pacientes, todos los cuales presentaban factores de riesgo de SSCs. El sNPWT redujo las SSI (OR: 0,39; i.c. del 95%: 0,29-0,52; número necesario a tratar (NNT): 20). El sNPWT redujo las probabilidades de dehiscencia de la herida (OR: 0,70; i.c. del 95%: 0,53-0,92; NNT: 26), seroma (OR: 0,23; i.c. del 95%: 0,11-0,45; NNT: 13) y necrosis (OR: 0,11; i.c. del 95%: 0,03-0,39; NNT: 12). La duración media de la estancia hospitalaria fue más corta en los pacientes que se sometieron a sNPWT (diferencia media: -1,75; i.c. del 95%: -2,69 a -0,81). El uso del dispositivo sNPWT en pacientes con factores de riesgo redujo la incidencia de SSCs y la duración media de la estancia hospitalaria.