Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications
| Autor: | Marja A. Boermeester, Pieter R Zwanenburg, Miryam C. Obdeijn, Berend T. Tol, Oren Lapid, Sarah L. Gans |
|---|---|
| Přispěvatelé: | Graduate School, ACS - Diabetes & metabolism, AII - Inflammatory diseases, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, AMS - Amsterdam Movement Sciences, Plastic, Reconstructive and Hand Surgery, Surgery, AMS - Rehabilitation & Development |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Wound dehiscence business.industry medicine.medical_treatment medicine.disease Confidence interval 03 medical and health sciences 0302 clinical medicine Hematoma 030220 oncology & carcinogenesis Negative-pressure wound therapy Meta-analysis Internal medicine Seroma Relative risk medicine Number needed to treat 030211 gastroenterology & hepatology Surgery business |
| Zdroj: | Annals of surgery, 272(1), 81-91. Lippincott Williams and Wilkins |
| ISSN: | 0003-4932 |
| DOI: | 10.1097/sla.0000000000003644 |
| Popis: | OBJECTIVE: The aim of this study was to evaluate the efficacy of iNPWT for the prevention of postoperative wound complications such as SSI. SUMMARY OF BACKGROUND DATA: The 2016 WHO recommendation on the use of iNPWT for the prevention of SSI is based on low-level evidence, and many trials have been published since. Preclinical evidence suggests that iNPWT may also prevent wound dehiscence, skin necrosis, seroma, and hematoma. METHODS: PubMed, EMBASE, CINAHL, and CENTRAL were searched for randomized and nonrandomized studies that compared iNPWT with control dressings. The evidence was assessed using the Cochrane Risk of Bias Tool, the Newcastle-Ottawa scale, and GRADE. Meta-analyses were performed using random-effects models. RESULTS: High level evidence indicated that iNPWT reduced SSI [28 RCTs, n = 4398, relative risk (RR) 0.61, 95% confidence interval [CI]: 0.49-0.76, P < 0.0001, I = 27%] with a number needed to treat of 19. Low level evidence indicated that iNPWT reduced wound dehiscence (16 RCTs, n = 3058, RR 0.78, 95% CI: 0.64-0.94). Very low-level evidence indicated that iNPWT also reduced skin necrosis (RR 0.49, 95% CI: 0.33-0.74), seroma (RR 0.43, 95% CI: 0.32-0.59), and length of stay (pooled mean difference -2.01, 95% CI: -2.99 to 1.14). CONCLUSIONS: High-level evidence indicates that incisional iNPWT reduces the risk of SSI with limited heterogeneity. Low to very low-level evidence indicates that iNPWT also reduces the risk of wound dehiscence, skin necrosis, and seroma. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|