Sahebally SM, et al. - Researchers investigated the impact of prophylactic negative pressure wound therapy (NPWT) on the rates of surgical site infection (SSI) in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. Reduced SSI rates but similar rates of seroma and wound dehiscence resulted from the application of NPWT on closed laparotomy wounds in general and colorectal surgery vs conventional nonpressure dressings.

Methods

• From inception until December 2017, relevant randomized clinical trials and nonrandomized studies were searched without language restrictions through PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases; the latest search was performed on December 31, 2017.
• Potential additional studies were further identified via screening bibliographies of retrieved studies.
• Unpublished reports, studies that examined NPWT (or standard nonpressure) dressings only without a comparator group, and studies that assessed the use of NPWT in open abdominal incisions were not included.
• Researchers found 198 citations and excluded 189.
• They used PRISMA guidelines to perform this meta-analysis and two authors independently extracted data.
• Statistical analysis was also carried out using a random-effects model.
• The primary and secondary outcomes were chosen before data collection and included SSI, and seroma and wound dehiscence rates, respectively.

Results

• This study included a total of 9 unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) with 1,266 unique patients.
• The final analysis included 1,187 patients with 1,189 incisions (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age).
• Among these studies, significant clinical and methodologic heterogeneity was evident.
• A significantly lower rate of SSI was noted in relation to NPWT vs standard dressings on random-effects analysis (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001).
• However, findings revealed no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P=.11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P=.25).
• A significant reduction was seen in SSI rates with NPWT on sensitivity analysis, focusing solely on colorectal procedures (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001).