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Prophylactic Negative Pressure Wound Therapy in Closed Abdominal Incisions: A Meta-analysis of Randomised Controlled Trials

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Abstract

Introduction

Negative pressure wound therapy (NPWT) may prevent subcutaneous fluid accumulation in a closed wound and subsequently reduce surgical site infections (SSI). This meta-analysis aimed to determine the effect of prophylactic NPWT on SSI incidence following abdominal surgery.

Methods

A systematic search of MEDLINE and EMBASE databases was performed using PRISMA methodology. All randomised trials reporting the use of NPWT in closed abdominal incisions were included, regardless of the type of operation. The primary outcome measure was the incidence of SSI, stratified by superficial and deep and organ/space infections. Secondary outcomes were wound dehiscence and length of hospital stay.

Results

Ten randomised trials met the inclusion criteria (five Caesarean, five midline laparotomy). The use of NPWT reduced overall SSI (11.6% vs. 16.7%, RR 0.67, 95% CI 0.48–0.95, p = 0.02). The rate of superficial SSI rate was also reduced (6.3% vs. 11.3%, RR 0.57, 95% CI 0.35–0.94, p = 0.03). There was no effect on deep or organ/space SSI (3.2% vs. 4.2%, RR 0.77, 95% CI 0.51–1.18, p = 0.23), wound dehiscence (9.7% vs. 10.9%, RR 0.92, 95% CI 0.69–1.21, p = 0.54), or length of hospital stay (MD 0.06 days, 95% CI–0.11 to 0.23, p = 0.51).

Conclusions

Prophylactic use of NPWT may reduce the incidence of superficial SSI in closed abdominal incisions but has no effect on deep or organ space SSI.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand

    Cameron I. Wells, Chathura B. B. Ratnayake, Jenni Perrin & Sanjay Pandanaboyana

  2. Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne NHS Trust, High Heaton, Newcastle upon Tyne, NE7 7DN, UK

    Sanjay Pandanaboyana

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  1. Cameron I. Wells
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Correspondence to Sanjay Pandanaboyana.

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Wells, C.I., Ratnayake, C.B.B., Perrin, J. et al. Prophylactic Negative Pressure Wound Therapy in Closed Abdominal Incisions: A Meta-analysis of Randomised Controlled Trials. World J Surg 43, 2779–2788 (2019). https://doi.org/10.1007/s00268-019-05116-6

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