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

Amar Lakhani; Wael Jamel; Georgina E Riddiough; Carlos S Cabalag; Sean Stevens; David S Liu

doi:10.1016/j.surg.2022.05.020

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

Surgery. 2022 Sep;172(3):949-954. doi: 10.1016/j.surg.2022.05.020. Epub 2022 Jun 30.

Authors

Amar Lakhani¹, Wael Jamel², Georgina E Riddiough³, Carlos S Cabalag⁴, Sean Stevens⁵, David S Liu⁶

Affiliations

¹ Northern Health, Epping, Victoria, Australia.
² Northern Health, Epping, Victoria, Australia; Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia.
³ 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.
⁴ 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.
⁵ 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.
⁶ 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. Electronic address: liu.davidsh@gmail.com.

PMID: 35779950
DOI: 10.1016/j.surg.2022.05.020

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.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Bandages
Humans
Laparotomy* / adverse effects
Negative-Pressure Wound Therapy*
Prospective Studies
Retrospective Studies
Surgical Wound Dehiscence / epidemiology
Surgical Wound Dehiscence / etiology
Surgical Wound Dehiscence / prevention & control
Surgical Wound Infection / epidemiology
Surgical Wound Infection / etiology
Surgical Wound Infection / prevention & control