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Esen E, Morkavuk SB, Turan M, Akyuz S, Guler S, Akgul GG, Bahcecioglu IB, Gulcelik MA, Yilmaz KB. The use of incisional negative pressure wound therapy on high-risk breast cancer mastectomy patients. Asian J Surg 2024:S1015-9584(24)01706-8. [PMID: 39164174 DOI: 10.1016/j.asjsur.2024.07.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/29/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND The main complications seen in patients who have undergone modified radical mastectomy (MRM) are seroma, surgical site infection, hematoma, wound dehiscence, flap necrosis, and nerve damage. While these complications lead to some problems the most feared effect in the early period is that they cause a delay in adjuvant treatment. Incisional Negative Pressure Wound Therapy (iNPWT) decreases wound dehiscence by reducing oedema and tension, especially in the incision line. This study aim to compare recovery times and wound site complications between patients treated with conventional wound dressings and patients treated with iNPWT after MRM. METHODS A retrospective screening was made of the data of 50 patients who underwent MRM because of breast cancer in the General Surgery Clinic of XXX Hospital between 2018 and 2022, and were at high-risk of wound site complications. Two groups were formed as 30 patients applied with iNPWT and 20 patients applied with conventional dressings. RESULTS The mean age of the 50 female patients was 53.58 years (range, 30-80 years). The most frequently seen complications were seroma (20 patients) and partial flap ischaemia (14 patients). The mean number of iNPWT applications was 1.30 (range, 1-2), and the mean number of days of application was 4.47 (range, 2-9). Postoperative seroma was observed in 8 patients in the iNPWT group and in 12 patients in the conventional dressings group (p = 0.018). Flap ischaemia and the probability of dehiscence was determined at a statistically significantly higher rate in the patients in the conventional dressings groups (p = 0.005, p = 0.021). CONCLUSION The results of this study demonstrated that the use of iNPWT significantly reduced the amount of postoperative drainage, thereby contributing to early drain removal. Furthermore, iNPWT significantly reduced postoperative seroma, flap ischaemia, and flap dehiscence compared to conventional dressings.
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Affiliation(s)
- Ebru Esen
- İstinye University, Bahçeşehir Liv Hospital, Department of Surgical Oncology, Istanbul, Turkey
| | - Sevket Baris Morkavuk
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Mujdat Turan
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Simay Akyuz
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Sumeyra Guler
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Gokhan Giray Akgul
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Ibrahim Burak Bahcecioglu
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Mehmet Ali Gulcelik
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey
| | - Kerim Bora Yilmaz
- University of Health Sciences, Gulhane Research and Training Hospital, Department of General Surgery, Ankara, Turkey.
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Borejsza-Wysocki M, Szmyt K, Jeske P, Bobkiewicz A, Ledwosiński W, Banasiewicz T, Krokowicz Ł. Analysis of risk factors for surgical site infection and other postoperative complications in patients following loop ileostomy reversal. POLISH JOURNAL OF SURGERY 2024; 96:44-49. [PMID: 39138989 DOI: 10.5604/01.3001.0054.4604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
<b>Introduction:</b> Loop ileostomy reversal (LIR) procedure is still associated with a relatively high risk of complications. Surgical site infection (SSI) is the most common complication in this group of patients. SSI leads to prolonged hospital stays, delays the adjuvant therapy, and increases hospital costs.<b>Aim:</b> The aim of the study was to analyze the risk factors for SSI in patients following loop ileostomy reversal procedure.<b>Material and methods:</b> A single-center retrospective analysis was conducted in a tertiary reference center. Finally, 65 patients following loop ileostomy reversal procedure performed between 2018 and 2022 were enrolled in the study. Data were collected retrospectively based on the available medical charts. The study group comprised 23 women (35%) and 42 men (65%) with a mean age of 48.9 14.5 years and a mean body mass index of 24.3 4.9 kg/m<sup>2</sup> . The most common indication for index surgery was ulcerative colitis (33%) and colorectal cancer (29%). Preferably, handsewn anastomosis was performed (n = 42; 64.6%).<b>Results:</b> The most important parameter evaluated in the above study was the diagnosis of surgical site infection, which influenced e.g. hospitalization after surgery, the need for antibiotic therapy, or C-reactive protein (CRP) values. Nine patients (13.8%) were diagnosed with SSI during their hospital stay (more than 86% without SSI). In the group with SSI, hospital stay exceeded 13 days compared to almost 6 days in the group without SSI (P = 0.00009). The time of the procedure had a statistically significant correlation with antibiotic therapy introduction (P = 0.01). The type of intestinal anastomosis had a significant impact on the operative time (P = 0.0011) and the time of hospital stay after surgery (P = 0.04).<b>Conclusions:</b> Most of the analyzed clinical factors were directly related to the impact on the duration of postoperative hospitalization. The duration of hospitalization is an independent and undeniable factor increasing the risk of other postoperative complications and significantly increasing the cost of hospitalization. Another factor that has a large clinical impact on postoperative treatment is the presence of comorbidities which make patients more likely to develop SSI, CRP increase, or the need for antibiotic therapy. An important factor was the level of CRP, the elevated value of which may be a predictor of many negative aspects in postoperative treatment.
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Affiliation(s)
- Maciej Borejsza-Wysocki
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
| | - Krzysztof Szmyt
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Pamela Jeske
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Adam Bobkiewicz
- Department of General, Endocrine and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poland
| | - Witold Ledwosiński
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
| | - Łukasz Krokowicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland
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Tobiano G, Chaboyer W, Tong MYT, Eskes AM, Musters SCW, Colquhoun J, Herbert G, Gillespie BM. Post-operative nursing activities to prevent wound complications in patients undergoing colorectal surgeries: A scoping review. J Clin Nurs 2024; 33:890-910. [PMID: 38013213 DOI: 10.1111/jocn.16933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/15/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
AIMS To identify postoperative interventions and quality improvement initiatives used to prevent wound complications in patients undergoing colorectal surgeries, the types of activities nurses undertake in these interventions/initiatives and how these activities align with nurses' scope of practice. DESIGN A scoping review. DATA SOURCES Three health databases were searched, and backward and forward citation searching occurred in April 2022. Research and quality improvement initiatives included focussed on adult patients undergoing colorectal surgery, from 2010 onwards. Data were extracted about study characteristics, nursing activities and outcomes. The 'Dimensions of the scope of nursing practice' framework was used to classify nursing activities and then the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework was used to synthesise the review findings. RESULTS Thirty-seven studies were included. These studies often reported negative wound pressure therapy and surgical site infection bundle interventions/initiatives. Nurses' scope of practice was most frequently 'Technical procedure and delegated medical care' meaning nurses frequently acted under doctors' orders, with the most common delegated activity being dressing removal. CONCLUSION The full extent of possible interventions nurses could undertake independently in the postoperative period requires further exploration to improve wound outcomes and capitalise on nurses' professional role. IMPACT STATEMENT Nurses' role in preventing postoperative wound complications is unclear, which may inhibit their ability to influence postoperative outcomes. In the postoperative period, nurses undertake technical activities, under doctors' orders to prevent wound infections. For practice, nurses need to upkeep and audit their technical skills. New avenues for researchers include exploration of independent activities for postoperative nurses and the outcomes of these activities. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE There may be opportunities to broaden nurses' scope of practice to act more autonomously to prevent wound complication. REPORTING METHOD Scoping Reviews (PRISMA-ScR) checklist. PATIENT OR PUBLIC CONTRIBUTION A health consumer interpreted the data and prepared the manuscript.
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Affiliation(s)
- Georgia Tobiano
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Wendy Chaboyer
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Parklands, Queensland, Australia
| | - Mavis Ying Ting Tong
- School of Nursing and Health Studies, The Metropolitan University of Hong Kong, Kowloon, Hong Kong
| | - Anne M Eskes
- School of Nursing and Midwifery, Griffith University, Parklands, Queensland, Australia
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Selma C W Musters
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Janelle Colquhoun
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
| | - Georgina Herbert
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Brigid M Gillespie
- Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Parklands, Queensland, Australia
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
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Zhu J, Sun Q, Xu W, Geng J, Feng Q, Zhao Z, Li S. Effect of Negative Pressure Wound Therapy on Surgical Site Infections following Stoma Reversal in Colorectal Surgery: A Meta-Analysis. J INVEST SURG 2023; 36:2175079. [PMID: 36740239 DOI: 10.1080/08941939.2023.2175079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical site infections (SSI) are common complications after surgery, which cause other complications and increase medical costs. However, the effect of negative-pressure wound therapy (NPWT) for the prevention of SSI at stoma reversal remains inconclusive, with controversial results. This meta-analysis aimed to evaluate the safety and efficacy of NPWT following stoma reversal in colorectal surgery to prevent SSI and other wound complications. METHODS We conducted a systematic search of the PubMed, EMBASE, and Cochrane Library databases for articles published up to July 2022 and identified relevant studies reporting the NPWT administration following stoma reversal in colorectal surgery compared with non-pressure dressing. The primary outcome was the incidence of SSI, and the secondary outcomes were hematoma, seroma, and length of hospital stay (LOS). RESULTS Nine studies were included in the meta-analysis, with 825 patients with (n = 310) or without (n = 515) NPWT. Pooled SSI rate was lower in the NPWT group than in the non-pressure dressing group (OR = 0.50; 95% CI: 0.29, 0.84; P = 0.01). There was no significant effect on hematoma (OR = 0.21; 95% CI: 0.03, 1.27; P = 0.09), seroma (OR = 0.26; 95% CI: 0.05, 1.28; P = 0.1) and LOS (MD = -0.16, 95% CI: -0.83, 0.51; P = 0.64). CONCLUSION The use of NPWT following stoma reversal in colorectal surgery reduced the incidence of SSI. However, this conclusion needs to be interpreted with caution, and further studies should be conducted to confirm in higher-quality RCTs.
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Affiliation(s)
- Junjia Zhu
- Department of General Surgery, Jiangyin People's Hospital, Nantong University, Jiangyin, China
| | - Qi Sun
- Department of General Surgery, Jiangyin People's Hospital, Nantong University, Jiangyin, China
| | - Wenlong Xu
- Department of General Surgery, Jiangyin People's Hospital, Nantong University, Jiangyin, China
| | - Jun Geng
- Department of Anesthesiology, Jiangyin People's Hospital, Nantong University, Jiangyin, China
| | - Qiang Feng
- Department of General Surgery, Jiangyin People's Hospital, Nantong University, Jiangyin, China
| | - Zhenguo Zhao
- Department of General Surgery, Jiangyin People's Hospital, Nantong University, Jiangyin, China
| | - Sen Li
- Department of General Surgery, Jiangyin People's Hospital, Nantong University, Jiangyin, China
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Asghari A, O’Connor MJ, Attalla P, Ewing E, Lee CJ, Greene A, Lee CN, Lifchez S, Sacks JM, Gosman A. Game Changers: Plastic and Reconstructive Surgery Innovations of the Last 100 Years. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5209. [PMID: 37593701 PMCID: PMC10431564 DOI: 10.1097/gox.0000000000005209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/11/2023] [Indexed: 08/19/2023]
Abstract
Background Innovation is an essential aspect of plastic and reconstructive surgery (PRS), whether it involves improving current processes or implementing radical change that disrupts the status quo. Collaborating and sharing innovations help advance the field of PRS as a whole. Methods An anonymous survey was administered to members of the American Association of Plastic Surgeons on their opinions of the top five innovations in PRS of the last 100 years. Results A list of 69 unique innovations were compiled; the top five innovations overall were microsurgery, myocutaneous flaps, craniofacial surgery, negative pressure wound therapy, and organ transplantation. This list was reviewed by the American Association of Plastic Surgeons Technology Committee, and expanded to 100 unique innovations. Conclusions We discuss why the above innovations were essential to the development of PRS, as well as the unique factors that can make a new product or procedure into something that remodels the field of PRS.
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Affiliation(s)
- Arya Asghari
- From California Northstate University College of Medicine, Elk Grove, Calif
| | | | | | - Emily Ewing
- Department of Psychology, University of Alabama, Birmingham, Ala
| | - Clara J. Lee
- Department of Plastic and Reconstructive Surgery, Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
| | - Arin Greene
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Clara N. Lee
- Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Scott Lifchez
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Md
| | - Justin M. Sacks
- Division of Plastic and Reconstructive Surgery, Washington University in St. Louis, St. Louis, Mo
| | - Amanda Gosman
- Department of Plastic and Reconstructive Surgery, Division of Plastic Surgery, University of California San Diego, La Jolla, Calif
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Cooper HJ, Singh DP, Gabriel A, Mantyh C, Silverman R, Griffin L. Closed Incision Negative Pressure Therapy versus Standard of Care in Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4722. [PMID: 36936465 PMCID: PMC10019176 DOI: 10.1097/gox.0000000000004722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/26/2022] [Indexed: 03/18/2023]
Abstract
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.
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Affiliation(s)
- H. John Cooper
- From the Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, N.Y
| | - Devinder P. Singh
- Department of Plastic Surgery, University of Miami Health System and Miller School of Medicine, Miami, Fla
| | | | | | - Ronald Silverman
- Department of Plastic Surgery, University of Maryland School of Medicine, Baltimore, Md
- Medical Solutions Division, 3M, St Paul, Minn
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OKAZAWA YU, KOJIMA YUTAKA, TAKEHARA KAZUHIRO, NOJIRI SHOUKO, AMEMIYA KOTA, TSUCHIYA YUKI, HONJO K, TAKAHASHI R, KAWAI MASAYA, SUGIMOTO KIICHI, TAKAHASHI MAKOTO, SAKAMOTO KAZUHIRO. Study of Purse-string Skin Closure Plus Negative-pressure Wound Therapy for Stoma Closure. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2022; 68:599-605. [PMID: 39081383 PMCID: PMC11284288 DOI: 10.14789/jmj.jmj22-0015-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 09/29/2022] [Indexed: 08/02/2024]
Abstract
Background Although purse-string skin closure (PSC) is an effective method for stoma closure considering wound infection, the period for scarring will be prolonged. The aim of this study was to assess whether negative-pressure wound therapy (NPWT) can reduce the wound-scarring period for PSC after stoma closure. Methods Patients who underwent stoma closure between January 2015 and August 2020 at our department were retrospectively assessed. Patients in the control group received only PSC, and patients in the NPWT group received both PSC and NPWT using the VAC® or PICO®. The primary endpoint of this study was the short-term reduction ratio (RR). The RR is calculated by the length, width, and depth of the wound of the stoma closure site. The secondary endpoints were scarring period and wound-related complications such as surgical site infection, dermatitis, bleeding, enterocutaneous fistula, and ventral hernia. Results Of the 53 patients included in this study, 21 had their stoma closed by PSC and 32 had their stoma closed by PSC plus NPWT. No significant differences were observed in patient characteristics or peri-operative states. The RR in the NPWT group was significantly smaller than that in the PSC group at 7 postoperative days (p=0.04). There was no difference in scarring period between the two groups (p=0.11).The rates of postoperative wound-related complications were similar in the two groups (control group: 4 (19%), NPWT group: 7 (21.9%), p=1.0). Conclusions Our study suggests that PSC plus NPWT might be more effective for wound healing after stoma closure than only PSC.
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Affiliation(s)
- YU OKAZAWA
- Corresponding author: Yu Okazawa, Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan, TEL: +81-3-3813-3111 FAX: +81-3-3813-0731 E-mail:
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Borejsza-Wysocki M, Bobkiewicz A, Francuzik W, Krokowicz L, Walczak D, Szmeja J, Banasiewicz T. Effect of closed incision negative pressure wound therapy on incidence rate of surgical site infection after stoma reversal: a pilot study. Wideochir Inne Tech Maloinwazyjne 2021; 16:686-696. [PMID: 34950263 PMCID: PMC8669980 DOI: 10.5114/wiitm.2021.106426] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/20/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The stoma reversal (SR) procedure is associated with a relatively high risk of perioperative complications with surgical site infection (SSI) as the most common. Recently closed incision negative pressure wound therapy (ciNPWT) was applied widely to prevent SSI. AIM To investigate the efficiency of ciNPWT in terms of the incidence rate of SSI after SR surgery. MATERIAL AND METHODS As an exploratory observational cohort study patients were treated either with ciNPWT (n = 15) or standard sterile dressing (SSD) (n = 15). CiNPWT was applied every 3 days whereas SSD was changed every day. Clinical evaluation for SSI signs, C-reactive protein level and pain assessment using the visual analogue scale (VAS) were analyzed. RESULTS The incidence rate of SSI was in 13% (2/15) in the ciNPWT group and 26% (4/15) in the SSD group (p = 0.651, OR = 0.44, 95% CI: 0.03-3.73). All patients in the SSD group who developed SSI presented both local and generalized signs of infection. Pain-VAS levels assessed on the 1st (MdnciNPWT = 4, MdnSSD = 5, p = 0.027, W = 51.5) and 3rd postoperative day (MdnciNPWT = 2, MdnSSD = 4, p = 0.014, W = 45.5) were significantly lower in the ciNPWT group than in the SSD group. CONCLUSIONS CiNPWT seems not to have a benefit to reduce SSI after the SR procedure. Further investigation is needed to establish firmly the benefit of using ciNPWT in this group of patients.
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Affiliation(s)
- Maciej Borejsza-Wysocki
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Adam Bobkiewicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Francuzik
- Department of Dermatology, Venerology and Allergology Charité – Universitätsmedizin, Berlin, Germany
| | - Lukasz Krokowicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Dominik Walczak
- Department of Oncological and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Gliwice, Poland
| | - Jacek Szmeja
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Banasiewicz
- Department of General, Endocrinological and Gastroenterological Oncology Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Carrano FM, Maroli A, Carvello M, Foppa C, Sacchi M, Crippa J, Clerico G, De Lucia F, Coppola E, Ben David N, Spinelli A. Negative-pressure wound therapy after stoma reversal in colorectal surgery: a randomized controlled trial. BJS Open 2021; 5:6460900. [PMID: 34904647 PMCID: PMC8669787 DOI: 10.1093/bjsopen/zrab116] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Stoma-reversal surgery is associated with high postoperative morbidity, including wound complications and surgical-site infections (SSIs). This study aims to assess whether the application of negative-pressure wound therapy (NPWT) can improve wound healing compared with conventional wound dressing. Methods This was a single-centre, superiority, open-label, parallel, individually randomized controlled trial. Patients undergoing stoma reversal were randomized (1 : 1) to receive NPWT or conventional wound dressing. The primary endpoint of the study was the rate of wound complications and SSIs after stoma closure. The secondary endpoints were postoperative wound pain, rate of wound healing after 30 days from stoma closure, and wound aesthetic satisfaction. Results Between June 2019 and January 2021, 50 patients were allocated to the NPWT group (all received NPWT, 49 were analysed); 50 patients were allocated to the conventional wound dressing group (48 received the treatment, 45 were analysed). No significant difference was found in wound-complication rate (10 per cent NPWT versus 16 per cent controls; odds ratio 0.61 (95 per cent c.i. 0.18 to 2.10), P = 0.542) and incisional SSI rate (8 per cent NPWT versus 7 per cent controls; odds ratio 1.24 (95 per cent c.i. 0.26 to 5.99), P = 1.000). The NPWT group showed less pain, higher aesthetic satisfaction (P < 0.0001), and a higher proportion of wound healing (92 versus 78 per cent; P = 0.081) compared with the control group. Conclusion NPWT does not reduce the incidence of SSI after stoma-reversal surgery compared with conventional wound dressing. However, NPWT improved the healing of uninfected wounds, reduced wound pain and led to better aesthetic outcomes. Registration number: NCT037812016 (clinicaltrials.gov).
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Affiliation(s)
- Francesco M Carrano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Annalisa Maroli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Michele Carvello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Caterina Foppa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Sacchi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Jacopo Crippa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Clerico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca De Lucia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Elisabetta Coppola
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Nadav Ben David
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Almansa-Saura S, Lopez-Lopez V, Eshmuminov D, Schneider M, Castellanos-Escrig G, Rodriguez-Valiente M, Crespo MJ, Groeben MVD, Lehmann K, Robles-Campos R. Prophylactic Use of Negative Pressure Therapy in General Abdominal Surgery: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2021; 22:854-863. [PMID: 33844934 DOI: 10.1089/sur.2020.407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Surgical site infections (SSIs) represent an economic burden to healthcare systems. The use of negative pressure wound therapy (NPWT) for SSI prophylaxis remains uncertain. Methods: A systematic literature search was conducted in Medline/PubMed, CINAHL, and Web of Science for relevant studies. The primary outcome was the evaluation of the effectiveness of NPWT for prophylaxis of SSI rates in general abdominal surgery. Secondary outcomes were rates of seroma and wound dehiscence, length of hospital stay, and re-admission rates. The statistical analysis was performed with random effect models. Results: A total of 3,193 patients from 20 articles (six randomized controlled trials [RCT], three prospective, eight retrospective, and three ambispective studies) were analyzed. Negative pressure wound therapy was associated with decreased rate of SSIs compared with standard dressing in a pooled analysis of non-randomized studies and RCTs (0.57; 95% confidence interval [CI], -0.4 to 0.8; p < 0.001). This result, however, needs to be challenged because of a significant statistical heterogeneity of the included studies (I2 = 71%; p < 0.01). A separate analysis of the six RCTs failed to confirm the superiority of NPWT (0.64; 95% CI, -0.4 to 1.04; p = 0.07), also disclosing significant heterogeneity. The analysis of secondary outcomes was only possible in combination of randomized and non-randomized studies because of incomplete datasets in RCTs. Re-admission rates were lower after NPWT and no difference was observed for the incidence of seroma, wound dehiscence, and length of hospital stay. Conclusions: Based on available evidence, the routine use of NPWT for SSI prophylaxis after laparotomy in general abdominal surgery cannot be generally recommended.
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Affiliation(s)
- Sonia Almansa-Saura
- Department of General, Visceral, and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Víctor Lopez-Lopez
- Department of General, Visceral, and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Dilmurodjon Eshmuminov
- Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marcel Schneider
- Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Gregorio Castellanos-Escrig
- Department of General, Visceral, and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Monica Rodriguez-Valiente
- Department of General, Visceral, and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - María Jesús Crespo
- Department of General, Visceral, and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | | | - Kuno Lehmann
- Department of Visceral Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Ricardo Robles-Campos
- Department of General, Visceral, and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
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Negative pressure therapy for stoma closure sites-a nonrandomised case control study. Int J Colorectal Dis 2021; 36:161-167. [PMID: 32929529 DOI: 10.1007/s00384-020-03749-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 02/04/2023]
Abstract
AIM The PICO (Smith & Nephew, UK) dressing is a single use negative pressure wound therapy (NPWT) system that is designed to be used for up to 7 days for closed wounds. We aimed to assess its use for stoma closure wounds. METHOD We conducted a retrospective analysis of stoma reversal wounds from April 2018 to June 2019. The wound was partially closed with an absorbable subcutaneous suture in a purse-string fashion. A 15 cm × 15 cm PICO dressing was applied directly over this wound. A control group who had received partial purse string closure with packing over the same time period was identified. Patients were contacted and information collected using a questionnaire. The primary outcome measure was the number of visits for dressing changes in the community. Further information was collected about length of stay, time to resolution of pain and return to work. RESULTS On average, the patients with PICO dressings attended the community nurses 1.9 times. The patients in the PICO group stated it took 1-2 weeks to return to full work/daily activities. The control group averaged attending the community nurse 11.9 times, and 33% had not returned to work/daily activities in 1-2 weeks. CONCLUSION Those who had a PICO dressing required fewer visits to the community nurse and the majority were able to return to work or resume usual activities within 1 to 2 weeks. This pilot study suggests that negative pressure dressings may be a useful aid for stoma closure site wounds.
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Prophylactic Negative-pressure Dressings Reduce Wound Complications and Resource Burden After Emergency Laparotomies. J Surg Res 2021; 257:22-31. [DOI: 10.1016/j.jss.2020.07.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/18/2020] [Accepted: 07/11/2020] [Indexed: 12/11/2022]
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Abstract
Zusammenfassung
Einleitung
Bei einer 69-jährigen Patientin kam es nach Umwandlung eines doppelläufigen in ein endständiges Kolostoma zu einer Wundheilungsstörung, welche aufgrund der Nähe zum Stoma schwer zu behandeln war. Wir entwickelten eine getunnelte subkutane endoskopische Unterdrucktherapie, um die Wunde verschlossen zu halten, sodass eine uneingeschränkte Funktion des Stomas möglich blieb.
Methode
Es wurden drei verschiedene offenporige Schlauchdrainagen verwendet. An das distale Ende einer Magensonde wurde entweder ein offenporiger PU-Schwamm (OPD), eine dünne, doppellagige Drainagefolie (OFD) oder ein mit der Drainagefolie umhüllter PU-Schwamm (OPFD) mittels Naht fixiert. Diese Drainagetypen unterscheiden sich im Durchmesser sowie in der Ansaugwirkung auf das Wundgewebe. Der parastomale Abszess wurde chirurgisch eröffnet und gespült. Daraufhin konnte der offenporige PU-Schwamm in die Wunde eingebracht werden. Der Unterdruckschlauch wurde über eine kleine Inzision wundfern ausgeleitet. Nach Wundverschluss per Naht konnte die Stomaplatte problemlos aufgeklebt werden. Ein Vakuum mit −125 mm Hg wurde etabliert. Die weiteren Verbandswechsel beinhalteten eine endoskopische Inspektion. Bei den erstmaligen Verbandswechseln von großporiger OPD und kleinporigerer OPFD musste die Wunde neu eröffnet und wieder chirurgisch verschlossen werden. Bei sauberen, granulierenden Wundverhältnissen wurde das Verbandsregime auf die kleinlumige OFD rotiert. Dieser Drainagetyp konnte ausschließlich endoskopisch gewechselt werden, eine weitere Wunderöffnung war nicht mehr notwendig.
Ergebnis
Durch die OPD konnte initial ein großflächiges Débridement und eine Wundverkleinerung erreicht werden, die Wunde musste für die Verbandswechsel jedoch wiedereröffnet werden. Auch bei der folgenden OPFD wurde die Wunde für den Verbandswechsel erneut eröffnet. Die doppellagige Folie um den PU-Schwamm führte hier zu einer geringeren Ansaugwirkung. Letztlich wurde mit der OFD eine rein endoskopisch zu versorgende Drainage etabliert, die keine weitere Manipulation an der Haut erforderte. Nach 16 Tagen endete die Therapie mit einer ausgeheilten Wunde und problemloser Stomaversorgung.
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The safety and efficacy of using negative pressure incisional wound VACs in pediatric and neonatal patients. J Pediatr Surg 2020; 55:1470-1474. [PMID: 31839369 DOI: 10.1016/j.jpedsurg.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/06/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical site infection (SSI) rates are an important surgical quality metric. Decreased SSI rates have been demonstrated using negative pressure incisional wound vac device (NPIWV) dressings in adults but have not been studied in children. MATERIALS AND METHODS A retrospective review of patients treated with NPIWV at our institution between February 2016 and February 2018 was performed. NPIWV dressings were applied by previously described techniques. Using the same CPT codes from our study patients, we queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) data between January 2014 and January 2016 to identify preimplementation controls (PIC). NPIWV patients were compared to historical controls to assess safety and efficacy of SSI prevention. RESULTS There were 32 patients managed with NPIWV, and 65 patients in the PIC group. There were no NPIWV-associated complications. There was a trend toward reduced incidence of SSI in NPIWV patients, with 1 SSI in 32 cases (3.1%) versus 7 SSIs in the 65 historical control patients (10.8%) (p = 0.22). CONCLUSIONS Our study shows that NPIWV dressings can be used safely in pediatric and neonatal patients undergoing surgery, with a trend toward decreased SSI rates. These findings should be confirmed in a larger, prospective trial. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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Evaluation of negative-pressure wound therapy for surgical site infections after ileostomy closure in colorectal cancer patients: a prospective multicenter study. Surg Today 2020; 50:1687-1693. [PMID: 32638132 DOI: 10.1007/s00595-020-02068-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Surgical site infection (SSI) occurs at a high rate after ileostomy closure. The effect of preventive negative-pressure wound therapy (NPWT) on SSI development in closed wounds remains controversial. We conducted a prospective multicenter study to evaluate the usefulness of preventive NPWT for SSI after ileostomy closure. METHODS From January 2018 to November 2018, 50 patients who underwent closure of ileostomy created after surgery for colorectal cancer participated in this study. An NPWT device was applied to each wound immediately after surgery and then treatment was continued for 3 days. The primary endpoint was 30-day SSI, and the secondary endpoints were the incidence of seroma, hematoma, and adverse events related to NPWT. RESULTS No patients developed SSI, seroma, or hematoma. Adverse events that may have been causally linked with NPWT were contact dermatitis in two patients and wound pain in one patient, and there were no cases of discontinuation or decompression of NPWT. CONCLUSION The use of NPWT following ileostomy closure may be useful for reducing the development of SSI in colorectal cancer patients. This is a prospective multicenter pilot study and we are planning a comparative study based on these successful results. TRAIL REGISTRATION Registration number: UMIN000032053 ( https://www.umin.ac.jp/ ).
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Savage N, Jain M, Champion R, Snell B. Incisional negative pressure wound therapy in bilateral breast reductions patients. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.34239/ajops.v3n1.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Incisional negative pressure wound therapy (iNPWT) has been applied to bilateral breast reduction patients and shown a reduction in surgical complications. However, its effects on opioid use and hospitalisation length in this patient group has not been investigated.Methods: In this single surgeon retrospective cohort study, 52 patients who underwent bilateral breast reduction were analysed, with 23 patients in the iNPWT cohort and 29 in the standard-of-care (SOC) wound dressing cohort. Hospitalisation length, postoperative opioid use and surgical site complications were compared between cohorts. Mean (range) follow-up time was 369.15 (77-1329) days.Results: Hospitalisation length in days was significantly less in the iNPWT cohort (1.35) than the SOC cohort (2.03). Total ward opioid use was significantly reduced in the iNPWT cohort (45.50mg) compared to the SOC cohort (62.50mg). Discharge opioid prescription was significantly reduced in the iNPWT cohort (125.50mg) compared to the SOC cohort (230.00mg). The number of surgical site complications was significantly different between the groups (p=0.014).Discussion: This study suggests the use of iNPWT in bilateral breast reduction provides significant benefit through the reduction of hospitalisation, complications and opioid use. Conclusion: This is the first study to provide evidence for iNPWT in bilateral breast reduction in reducing postoperative opioid use and hospitalisation. It supports current literature showing a reduction in surgical site complications using iNPWT in bilateral breast reduction.
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Kim S, Kang SI. The effectiveness of negative-pressure wound therapy for wound healing after stoma reversal: a randomised control study (SR-PICO study). Trials 2020; 21:24. [PMID: 31907033 PMCID: PMC6945515 DOI: 10.1186/s13063-019-3925-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/21/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although the wound-healing period for purse-string closure (PSC) after stoma reversal is longer than that required for the primary closure method, the rate of wound infection is reduced. The application of negative-pressure wound therapy (NPWT) can reduce the healing period for many types of wounds. Herein, we describe a planned trial to test the hypothesis that NPWT can reduce the healing period for PSC after stoma reversal. METHODS/DESIGN Patients undergoing stoma reversal will be recruited and allocated into intervention and control groups, with 1:1 randomisation. Patients in the control group will receive standard postsurgical wound care; patients in the intervention group will receive NPWT using the PICO™ system. The target sample size will be 38 patients, as this will provide 80% power at the 5% level of significance to detect a 7-day reduction in the wound-healing period in the intervention group compared to that in the control group. The primary endpoint will be the duration to wound healing, defined as the time to nearly complete epithelisation of the wound, without any discharge or surgical site infection (SSI). Secondary endpoints will be the SSI rate, length of postoperative hospital stay, number of wound dressings and visits to the hospital for wound dressing after discharge, total cost of wound dressings, and patient and observer scar assessment scale scores. DISCUSSION The results of this planned randomised controlled study will clarify the role of NPWT in patients undergoing stoma reversal and strengthen the rationale for choosing a dressing technique. TRIAL REGISTRATION Clinical Research Information Service (CRIS), KCT0004063. Registered on 6 June 2019.
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Affiliation(s)
- Sohyun Kim
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea
| | - Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, South Korea.
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Meta-Analysis of Comparative Trials Evaluating a Single-Use Closed-Incision Negative-Pressure Therapy System. Plast Reconstr Surg 2019; 143:41S-46S. [PMID: 30586103 DOI: 10.1097/prs.0000000000005312] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Surgical site infections (SSIs) pose a significant surgical complication. Application of closed-incision negative-pressure therapy (ciNPT) has been associated with reduced SSI rates in published literature. This meta-analysis examines the effect of ciNPT use over closed incisions in reducing SSIs versus traditional dressings. METHODS A systematic literature search using PubMed, The Cochrane Library, OVID, EMBASE, ScienceDirect, and QUOSA was performed focusing on publications between January 1, 2005, and April 30, 2018. Characteristics of study participants, surgical procedure, type of dressing used, duration of treatment, incidence of SSI, and length of follow-up were extracted. Weighted odds ratios and 95% CIs were calculated to pool study and control groups in each publication for analysis. Treatment effects were combined using Mantel-Haenszel odds ratios as the summary statistics, and a fixed-effects model was used for each analysis performed. The chi-square test was used to statistically assess heterogeneity. For each meta-analysis performed, the more conservative random-effects models were conducted as sensitivity analyses. RESULTS For all meta-analyses (randomized controlled trial only, observational studies only, colorectal/abdominal, obstetrics, lower extremity, groin/vascular, cardiac), heterogeneity tests were nonsignificant (P > 0.05). All fixed-effects meta-analyses were significant in favor of ciNPT use over traditional dressings (P < 0.05). When the random-effects analyses were performed, all analyses except obstetrics remained significant (P < 0.05). CONCLUSION For all meta-analyses performed using the fixed-effects approach, ciNPT usage demonstrated a statistically significant reduction in incidence of SSI relative to traditional dressings.
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