K. Chopra1, N. N. Semsarzadeh1, K. K. Tadisina1, J. Maddox1, D. P. Singh1 1University Of Maryland School Of Medicine,Division Of Plastic Surgery,Baltimore, MARYLAND, USA
Introduction: Negative pressure therapy has been increasingly used to treat open wounds over the past two decades. More recently, studies have reported the use of negative pressure therapy over closed incisions to decrease surgical site occurrences including infection and dehiscence. To assess cumulative status of reported findings, we conducted a meta-analysis of the current literature to evaluate the effectiveness of incisional negative pressure wound therapy (iNPWT) in lowering the incidence of surgical site infections (SSIs) as compared to standard dressings.
Methods: PubMed, the Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched through August 2014 for publications comparing iNPWT to standard incisional care. A meta-analysis including 4631 participants from 14 published studies was performed. A fixed effects meta-analytical model was used to assess between-study heterogeneity and effect size, and funnel plots were used to assess publication bias.
Results: The overall rates of surgical site infection in the incisional negative pressure wound therapy group and control groups were 6.61% and 9.36%, respectively. Individual Odds Ratios or relative SSI likelihood rates by incision site location were 56% (p = 0.01) for the abdomen, 37% (p = 0.002) for the chest, 19% (p = 0.0001) for the groin, and 55% for the lower extremity (p = 0.022). The use of iNPWT was found to decrease SSI rate by 56% across all incision site regions considered together (p < 0.0001). However, a sensitivity analysis of heterogeneity (i.e., sub-group analysis) resulted in the three groin area studies being dropped and a final result that yielded an odds ratio of 0.504 (p = 0.0001), indicating a 50% reduction in SSI rate with iNPWT relative to standard care. Additionally, 9 of the 14 studies reported dehiscence rates among the two groups. Overall rates of dehiscence in the iNPWT and control groups were 5.32% and 10.68%, respectively. Heterogeniety was very high (I2 = 84%) and consequently data were not considered for further analysis. However, the effect size, Odds Ratio = 0.5 (CI 0.30 to 0.85), was significant, suggesting a correlation between iNPWT and lower dehiscence.
Conclusion: The results of the quantitative meta-analysis suggest that iNPWT is an effective method for reducing SSIs. It also appears that iNPWT may be associated with a decreased incidence of dehiscence although the evidence is still inconclusive.
