Meta-Analysis of Comparative Trials Evaluating a Single-Use Closed-Incision Negative-Pressure Therapy System.
Journal
Plastic and reconstructive surgery
ISSN: 1529-4242
Titre abrégé: Plast Reconstr Surg
Pays: United States
ID NLM: 1306050
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
entrez:
27
12
2018
pubmed:
27
12
2018
medline:
16
4
2019
Statut:
ppublish
Résumé
Surgical site infections (SSIs) pose a significant surgical complication. Application of closed-incision negative-pressure therapy (ciNPT) has been associated with reduced SSI rates in published literature. This meta-analysis examines the effect of ciNPT use over closed incisions in reducing SSIs versus traditional dressings. A systematic literature search using PubMed, The Cochrane Library, OVID, EMBASE, ScienceDirect, and QUOSA was performed focusing on publications between January 1, 2005, and April 30, 2018. Characteristics of study participants, surgical procedure, type of dressing used, duration of treatment, incidence of SSI, and length of follow-up were extracted. Weighted odds ratios and 95% CIs were calculated to pool study and control groups in each publication for analysis. Treatment effects were combined using Mantel-Haenszel odds ratios as the summary statistics, and a fixed-effects model was used for each analysis performed. The chi-square test was used to statistically assess heterogeneity. For each meta-analysis performed, the more conservative random-effects models were conducted as sensitivity analyses. For all meta-analyses (randomized controlled trial only, observational studies only, colorectal/abdominal, obstetrics, lower extremity, groin/vascular, cardiac), heterogeneity tests were nonsignificant (P > 0.05). All fixed-effects meta-analyses were significant in favor of ciNPT use over traditional dressings (P < 0.05). When the random-effects analyses were performed, all analyses except obstetrics remained significant (P < 0.05). For all meta-analyses performed using the fixed-effects approach, ciNPT usage demonstrated a statistically significant reduction in incidence of SSI relative to traditional dressings.
Sections du résumé
BACKGROUND
Surgical site infections (SSIs) pose a significant surgical complication. Application of closed-incision negative-pressure therapy (ciNPT) has been associated with reduced SSI rates in published literature. This meta-analysis examines the effect of ciNPT use over closed incisions in reducing SSIs versus traditional dressings.
METHODS
A systematic literature search using PubMed, The Cochrane Library, OVID, EMBASE, ScienceDirect, and QUOSA was performed focusing on publications between January 1, 2005, and April 30, 2018. Characteristics of study participants, surgical procedure, type of dressing used, duration of treatment, incidence of SSI, and length of follow-up were extracted. Weighted odds ratios and 95% CIs were calculated to pool study and control groups in each publication for analysis. Treatment effects were combined using Mantel-Haenszel odds ratios as the summary statistics, and a fixed-effects model was used for each analysis performed. The chi-square test was used to statistically assess heterogeneity. For each meta-analysis performed, the more conservative random-effects models were conducted as sensitivity analyses.
RESULTS
For all meta-analyses (randomized controlled trial only, observational studies only, colorectal/abdominal, obstetrics, lower extremity, groin/vascular, cardiac), heterogeneity tests were nonsignificant (P > 0.05). All fixed-effects meta-analyses were significant in favor of ciNPT use over traditional dressings (P < 0.05). When the random-effects analyses were performed, all analyses except obstetrics remained significant (P < 0.05).
CONCLUSION
For all meta-analyses performed using the fixed-effects approach, ciNPT usage demonstrated a statistically significant reduction in incidence of SSI relative to traditional dressings.
Identifiants
pubmed: 30586103
doi: 10.1097/PRS.0000000000005312
pii: 00006534-201901001-00011
doi:
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
41S-46SRéférences
Centers for Disease Control and Prevention. 2014 National and State Healthcare-Associated Infections Progress Report. 2016Atlanta, GA: Centers for Disease Control and Prevention; . Available at: http://www.cdc.gov/hai/surveillance/progress-report/index.html. May 2, 2016.
Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173:20392046.
Schweizer ML, Cullen JJ, Perencevich EN, et al. Costs associated with surgical site infections in Veterans Affairs hospitals. JAMA Surg. 2014;149:575581.
Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012;13:234237.
Zaidi A, El-Masry S. Closed incision negative pressure therapy in high-risk general surgery patients following laparotomy: a retrospective study. Colorectal Dis. 2017;19:283287.
Swift SH, Zimmerman MB, Hardy-Fairbanks AJ. Effect of single-use negative pressure wound therapy on postcesarean infections and wound complications for high-risk patients. J Reprod Med. 2015;60:211218.
Law A, Griffin L. Comparison of quality metrics for patients undergoing total hip and knee arthroplasty with and without closed incision negative pressure therapy. Proceedings of the 2017 Symposium on Advanced Wound Care. April 5-9, 2017, San Diego, CA.
Matatov T, Reddy KN, Doucet LD, et al. Experience with a new negative pressure incision management system in prevention of groin wound infection in vascular surgery patients. J Vasc Surg. 2013;57:791795.
Grauhan O, Navasardyan A, Tutkun B, et al. Effect of surgical incision management on wound infections in a poststernotomy patient population. Int Wound J. 2014;11(suppl 1):69.
Semsarzadeh NN, Tadisina KK, Maddox J, et al. Closed incision negative-pressure therapy is associated with decreased surgical-site infections: a meta-analysis. Plast Reconstr Surg. 2015;136:592602.
Benrashid E, Guest K, Mantyh CR, et al. The implementation of a vascular preventative bundle to decrease surgical site infections: early institutional experience. Proc South Assoc Vasc Surg. January 17-20, 2018. Scottsdale, AZ. http://meeting.savs.org/abstracts/2018/P3.cgi. Accessed June 3, 2018.
Cantero R, Rubio-Perez I, Leon M, et al. Negative-pressure therapy to reduce the risk of wound infection following diverting loop ileostomy reversal: an initial study. Adv Skin Wound Care. 2016;29:114118.
Cooper HJ, Bas MA. Closed-incision negative-pressure therapy versus antimicrobial dressings after revision hip and knee surgery: a comparative study. J Arthroplasty. 2016;31:10471052.
Cooper HJ, Roc GC, Bas MA, et al. Closed incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee. Injury. 2018;49:386391.
DiMuzio P, Staley C, Reiter D, et al. RS06: a randomized study evaluating negative-pressure therapy to decrease vascular groin wound complications. J Vasc Surg. 2017;65:133S.
Engelhardt M, Rashad NA, Willy C, et al. Closed-incision negative pressure therapy to reduce groin wound infections in vascular surgery: a randomised controlled trial. Int Wound J. 2018;15:327332.
Gabriel A, Sigalove S, Sigalove N, et al. Does closed-incision, negative-pressure therapy impact post-operative outcomes of breast reconstruction? Ann Surg Oncol. 2017;24:279280.
Gombert A, Babilon M, Barbati M, et al. Closed-incision negative-pressure therapy reduces surgical site infections in vascular surgery: a prospective randomised multicentre trial (AIMS trial). Eur J Vasc Endovasc Surg. 2018;56:442448.
Grauhan O, Navasardyan A, Hofmann M, et al. Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg. 2013;145:13871392.
Gunatilake RP, Swamy GK, Brancazio LR, et al. Closed-incision negative-pressure therapy in obese patients undergoing cesarean delivery: a randomized controlled trial. AJP Rep. 2017;7:e151e157.
Hussamy DJ, Wortman AC, McIntire DD, et al. 45: A randomized trial of closed incision negative pressure therapy in morbidly obese women undergoing cesarean delivery. (Presented at the Society for Maternal-Fetal Medicine 38th Annual Meeting, The Pregnancy Meeting, January 29-February 3, 2018, Dallas, TX). Am J Obstet Gynecol. 2018;218:S35.
Lavryk O, Ashburn J, Liska D, et al. Incisional negative pressure wound therapy reduces surgical site infections in complex colorectal surgery patients. Dis Colon Rectum. 2016;59:e380.
Lee AJ, Sheppard CE, Kent WD, et al. Safety and efficacy of prophylactic negative pressure wound therapy following open saphenous vein harvest in cardiac surgery: a feasibility study. Interact Cardiovasc Thorac Surg. 2017;24:324328.
Lee K, Murphy PB, Ingves MV, et al. Randomized clinical trial of negative pressure wound therapy for high-risk groin wounds in lower extremity revascularization. J Vasc Surg. 2017;66:18141819.
Nagle D, Curran T, Alvarez D, et al. Closed incision negative pressure wound therapy is associated with decreased surgical site infection in high-risk colorectal surgery laparotomy wounds. (Presented at the 2017 Annual Meeting of the American Society of Colon and Rectal Surgeons, June 10–14, 2017, Seattle, WA). Dis Colon Rectum. 2017;60:e71e72.
Newman JM, Siqueira MBP, Yakubek GA, et al. Use of closed incisional negative pressure wound therapy after revision total hip and knee arthroplasty in patients at high risk for infection - a prospective randomized clinical trial. J Arthroplasty. (in press). Available at: https://doi.org/10.1016/j.arth.2018.11.017.
Nickl S, Steindl J, Langthaler D, et al. First experiences with incisional negative pressure wound therapy in a high-risk poststernotomy patient population treated with pectoralis major muscle flap for deep sternal wound infection. J Reconstr Microsurg. 2018;34:17.
Orth TA, Gerkovich MM, Heitmann E, et al. Cesarean delivery with external negative pressure dressing system: a retrospective cohort study. Surg J (N Y). 2016;2:e59e65.
Pleger SP, Nink N, Elzien M, et al. Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single-institution study. Int Wound J. 2018;15:7583.
Poehnert D, Hadeler N, Schrem H, et al. Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy. Wound Repair Regen. 2017;25:9941001.
Redfern RE, Cameron-Ruetz C, O’Drobinak SK, et al. Closed incision negative pressure therapy effects on postoperative infection and surgical site complication after total hip and knee arthroplasty. J Arthroplasty. 2017;32:33333339.
Ruhstaller K, Downes KL, Chandrasekaran S, et al. Prophylactic wound vacuum therapy after cesarean section to prevent wound complications in the obese population: a randomized controlled trial (the ProVac study). Am J Perinatol. 2017;34:11251130.
Sabat J, Tyagi S, Srouji A, et al. IP123 - prophylactic negative-pressure therapy for femoral incision in vascular surgery: preliminary results of a prospective, randomized trial. (Presented at the 2016 Vascular Annual Meeting, June 8–11, 2016, National Harbor, MD). J Vasc Surg. 2016;63:94S95S.
Santarpino G, Gazdag L, Sirch J, et al. A retrospective study to evaluate use of negative pressure wound therapy in patients undergoing bilateral internal thoracic artery grafting. Ostomy Wound Manage. 2015;61:2630.
Schurtz E, Differding J, Jacobson E, et al. Evaluation of negative pressure wound therapy to closed laparotomy incisions in acute care surgery. Am J Surg. 2018;215:113115.
Cook DJ, Sackett DL, Spitzer WO. Methodologic guidelines for systematic reviews of randomized control trials in health care from the Potsdam Consultation on Meta-Analysis. J Clin Epidemiol. 1995;48:167171.