Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis

Abstract

Surgical site complications (SSCs), such as surgical site infection (SSI), dehiscence, seroma, hematoma, and skin necrosis, are associated with increased patient morbidity and mortality. 1 Patients who develop SSCs often experience delayed wound healing, decreased quality of life, and increases in length of stay (LOS), medical procedures performed, pain, and potential reoperation and readmission. [1][2][3] Increased use of resources with management Reconstructive ORiginal aRticleIntroduction: Closed incision negative pressure therapy (ciNPT) has been utilized to help manage closed incisions across many surgical specialties. This systematic review and meta-analysis evaluated the effect of ciNPT on postsurgical and health economic outcomes. Methods: A systematic literature search using PubMed, EMBASE, and QUOSA was performed for publications written in English, comparing ciNPT to standard-of-care dressings between January 2005 and August 2021. Study participant characteristics, surgical procedure, dressings used, treatment duration, postsurgical outcomes, and follow-up data were extracted. Meta-analyses were performed using random-effects models. Risk ratios summarized dichotomous outcomes. Difference in means or standardized difference in means was used to assess continuous variables reported on the same scale or outcomes reported on different scales/measurement instruments. Results: The literature search identified 84 studies for analysis. Significant reductions in surgical site complication (SSC), surgical site infection (SSI), superficial SSI, deep SSI, seroma, dehiscence, skin necrosis, and prolonged incisional drainage were associated with ciNPT use (P < 0.05). Reduced readmissions and reoperations were significant in favor of ciNPT (P < 0.05). Patients receiving ciNPT had a 0.9-day shorter hospital stay (P < 0.0001). Differences in postoperative pain scores and reported amounts of opioid usage were significant in favor of ciNPT use (P < 0.05). Scar evaluations demonstrated improved scarring in favor of ciNPT (P < 0.05). Discussion: For these meta-analyses, ciNPT use was associated with statistically significant reduction in SSCs, SSIs, seroma, dehiscence, and skin necrosis incidence. Reduced readmissions, reoperation, length of hospital stay, decreased pain scores and opioid use, and improved scarring were also observed in ciNPT patients.

Surgical site infection outcomes of two different closed incision negative pressure therapy systems in cardiac surgery: Systematic review and meta‐analysis

“…However, a mix of ciNPT systems were compared to SOC dressings in the Biancari et al and Tao et al meta‐analyses, whereas the results reported in this work limited and differentiated ciNPT to two systems (ciNPT‐F and ciNPT‐MLA). While no other cardiac surgery specific meta‐analyses have been published, other published articles have assessed rates of SSI following ciNPT use 33–43 . The Singh et al meta‐analysis compared the use of ciNPT‐F and ciNPT‐MLA against SOC dressings to assess clinical outcomes after surgery, including a mix of surgical specialty types within the analysis 33 .…”

“…Five meta‐analyses reported reduced SSI rates with ciNPT use compared to SOC dressings across a mix of surgical specialties and ciNPT systems 34–39 . Two ciNPT‐F‐specific meta‐analyses have reported reduced SSI with ciNPT use across all surgical specialties 40,41 . When Singh et al assessed cardiac surgery separately, ciNPT‐F also showed reduced rates of SSI when compared to SOC dressings 41 .…”

Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

“…This contradicts several studies demonstrating decreased surgical site infection rates with ciNPWT. [5][6][7][8][9]11,13,14,30,33,36,41,[43][44][45][46][47][48][49][50][51][52][54][55][56][57][58][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] However, the occurrence of infection in DIEP flaps is infrequent, with a recent meta-analysis reporting a donor site infection rate of 4.79%. 77 Mechanistically, ciNPWT acts as a barrier that prevents contamination of the surgical site with bacteria before reepithelization, encourages drainage of excess interstitial fluid, increases lymphatic flow, improves blood flow, and induces angiogenesis, theoretically decreasing the risk of infection and expediting healing.…”

“…27,33,38 Our findings on seroma rates were similarly not statistically significant (P = 0.63). Some studies demonstrate a benefit on rates of seroma with the use of ciN-PWT, 11,41,44,49,50,52,54,55,63 but results are mixed. [6][7][8][13][14][15]33,45,48,61 Seromas develop as a result of the accumulation of serum in internal spaces.…”

“…17,27,31–42 Our finding is congruent with other studies examining ciNPWT in orthopedic trauma, 5,43 breast surgery, 11,14,15,44 abdominal wall reconstruction, 34,45 laparotomy, 46,47 ventral hernia repair, 48 and reviews combing multiple types of procedures. 36,41,45,49–52 However, results in the literature are mixed, and other studies do not show this relationship. 6–9,13,33,53–58 In the context of DIEP flaps, wound dehiscence is frequently attributed to suturing under tension and the extended length of the incision.…”