Back to Annual Meeting
Does the application of incisional negative pressure therapy to high-risk wounds prevent surgical site complications?: An evidence-based systematic review & meta-analysis
Lily N. Daniali, M.D., Michael Ingargiola, B.S., Edward S. Lee, M.D..
University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
Background: The application of incisional negative pressure wound therapy (INPWT) to clean, closed surgical incisions is a growing clinical practice. A systematic review and meta-analysis were conducted to evaluate the evidence for the effect of INPWT on surgical sites healing by primary intention. The primary outcomes of interest are incidence of surgical site complications (infection, dehiscence, seroma, hematoma, skin necrosis or blistering).
Methods: Two independent reviewers performed a search of the Ovid MEDLINE and EMBASE databases from 2006 to October 2012 for published articles. Supplemental searches were performed using reference lists and conference proceedings. Studies were selected for inclusion based on predetermined inclusion and exclusion criteria. Data extraction regarding study quality, demographic and clinical characteristics, and outcomes was performed independently, and data on the incidence of infection was combined using a fixed-effects meta-analysis model.
Results: Ten (5 randomized controlled trials and 5 observational) studies were included, investigated the outcomes of 626 incisions on 610 patients. Six studies compared INPWT with standard dry dressings (SDD). There was a significant decrease in the incidence of infection with application of INPWT to lower extremity reconstructive surgical sites (OR 0.5 with 95 percent confidence interval, 0.28 to 0.92; p = 0.02). The calculated NNT for prevention of an infection with application of INPWT to the surgical site of a lower extremity reconstruction was 16.
Conclusions: This systematic review and meta-analysis provides evidence of a decrease in the incidence of infection with application of INPWT to lower extremity reconstruction surgical sites. Currently, as the present body of literature focuses on patient cohorts with significant co-morbidities and risk factors for surgical site complication, there is insufficient evidence in support for the generalized application of INPWT to all surgical incisions.
Level of Evidence: 1
Back to Annual Meeting