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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Article info
Publication history
Published online: June 30, 2022
Accepted:
May 18,
2022
Footnotes
Amar Lakhani and Wael Jamel are joint first authors.
Author contributions: AL: data collection, analysis, interpretation, manuscript drafting and final approval. JW: data collection, analysis, interpretation, manuscript drafting and final approval. GER: study design, data interpretation, manuscript drafting and final approval. CSC: study design, data analysis, interpretation, manuscript drafting and final approval. SS: study design, data interpretation, study supervision, manuscript drafting and final approval. DSL: study conceptualization, design, data interpretation, study supervision, manuscript drafting and final approval.
Identification
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