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Prophylactic negative pressure wound dressings reduces wound complications following emergency laparotomies: A systematic review and meta-analysis

  • Amar Lakhani
    Affiliations
    Northern Health, Epping, Victoria, Australia
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  • Wael Jamel
    Affiliations
    Northern Health, Epping, Victoria, Australia

    Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia
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  • Georgina E. Riddiough
    Affiliations
    Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia

    The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia

    Department of Infectious Diseases, The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Victoria, Australia
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  • Carlos S. Cabalag
    Affiliations
    Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia

    General and Gastrointestinal Surgery Research Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
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  • Sean Stevens
    Affiliations
    Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia

    The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia

    General and Gastrointestinal Surgery Research Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
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  • David S. Liu
    Correspondence
    Reprint requests: David S. Liu, PhD, FRACS, General and Gastrointestinal Surgery Research Group, The University of Melbourne, Department of Surgery, Austin Precinct. Division of Surgery, Anaesthesia, and Perioperative Medicine, Austin Hospital, Heidelberg, Victoria, 3084, Australia.
    Affiliations
    Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia

    The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia

    General and Gastrointestinal Surgery Research Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia

    Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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      Abstract

      Background

      Wound complications are a common cause of postoperative morbidity and incur significant healthcare costs. Recent studies have shown that negative pressure wound dressings reduce wound complication rates, particularly surgical site infections, after elective laparotomies. The clinical utility of prophylactic negative pressure wound dressings for closed emergency laparotomy incisions remains controversial. This meta-analysis investigated the rates of wound complications after emergency laparotomy when a negative pressure wound dressing was applied.

      Methods

      A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Cochrane Registry, Web of Science, and Clinialtrials.gov databases were searched from January 1, 2005, to April 1, 2022. All studies comparing negative pressure wound dressings to standard dressings on closed emergency laparotomy incisions were included.

      Results

      A total of 1,199 (negative pressure wound dressings: 566, standard dressing: 633) patients from 7 (prospective: 4, retrospective: 3) studies were identified. Overall, the surgical site infection (superficial/deep) rate was 13.6% (77/566) vs 25.1% (159/633) in the negative pressure wound dressing versus standard dressing groups, respectively (odds ratio 0.43, 95% confidence interval 0.30–0.62). Wound breakdown (skin/fascial dehiscence) was significantly lower in the negative pressure wound dressing (7.7%) group compared to the standard dressing (16.9%) group (odds ratio 0.36, 95% confidence interval 0.19–0.72). The incidence of overall wound complications was significantly lower in the negative pressure wound dressing (15.9%) group compared to the standard dressing (30.4%) group (odds ratio 0.41, 95% confidence interval 0.28–0.59). No significant differences were found in hospital length-of-stay and readmission rates.

      Conclusion

      Prophylactic negative pressure wound dressings for closed emergency laparotomy incisions were associated with a significant reduction in surgical site infections, wound breakdown, and overall wound complications, thus supporting its clinical use.
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