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Goldman T, Costa B. A Systematic Review and Meta-analysis of Two Negative Pressure Wound Therapy Devices to Manage Cesarean Section Incisions. Am J Perinatol 2024; 41:e2786-e2798. [PMID: 37726017 PMCID: PMC11150062 DOI: 10.1055/s-0043-1775562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 08/17/2023] [Indexed: 09/21/2023]
Abstract
This paper aims to evaluate whether there is a device-dependent effect on the reduction of surgical site complications in obese patients (body mass index [BMI] ≥ 30 kg/m2) undergoing cesarean section (C-section). PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched for the period, January 2011 to September 2021. English language articles describing a randomized controlled trial (RCT) that compared either a -80 or -125 mm Hg single-use negative pressure wound therapy (sNPWT) device to standard dressings in obese (BMI ≥ 30 kg/m2) patients undergoing C-section were included. Conference abstracts and "terminated" RCTs with published results were deemed eligible for inclusion. The primary outcome of interest was surgical site infection (SSI), classified as composite, superficial, or deep. Secondary outcomes assessed included seroma, dehiscence, hematoma, bleeding, reoperation, readmission, blistering, and (composite) wound complications. A total of 223 titles were identified, of which 129 were screened by full-text review. Eleven RCTs encompassing 5,847 patients met the inclusion criteria and were considered eligible for further analysis (-80 mm Hg: six studies; -125 mm Hg: five studies). A statistically significant improvement in the composite SSI (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.54-0.89) and superficial SSI (OR: 0.66; 95% CI: 0.50-0.86) outcomes was observed with the -80 mm Hg device, compared with standard dressings. The same effect on SSI outcomes was not observed with the -125 mm Hg device (composite SSI-OR: 0.91; 95% CI: 0.64-1.28; superficial SSI-OR: 1.12; 95% CI: 0.70-1.78). There were no statistically significant differences in any of the other assessed outcomes. sNPWT devices may differ in their ability to reduce composite or superficial SSI after C-section. KEY POINTS: · Negative pressure benefits obese patients undergoing C-section.. · Negative pressure devices may differ in performance.. · A head-to-head clinical trial is needed..
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Affiliation(s)
- Theodore Goldman
- Obstetrics and Gynecology, Northwell Health, Huntington, New York
| | - Ben Costa
- Global Clinical and Medical Affairs, Smith + Nephew, Hull, United Kingdom
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Lam S, Huynh A, Ying T, Sandroussi C, Gracey D, Pleass HC, Chadban S, Laurence JM. Prospective evaluation of a closed-incision negative pressure wound therapy system in kidney transplantation and its association with wound complications. FRONTIERS IN NEPHROLOGY 2024; 4:1352363. [PMID: 38476464 PMCID: PMC10929013 DOI: 10.3389/fneph.2024.1352363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
Introduction Wound complications can cause considerable morbidity in kidney transplantation. Closed-incision negative pressure wound therapy (ciNPWT) systems have been efficacious in reducing wound complications across surgical specialties. The aims of this study were to evaluate the use of ciNPWT, Prevena™, in kidney transplant recipients and to determine any association with wound complications. Material and methods A single-center, prospective observational cohort study was performed in 2018. A total of 30 consecutive kidney transplant recipients deemed at high risk for wound complications received ciNPWT, and the results were compared to those of a historical cohort of subjects who received conventional dressings. Analysis for recipients with obesity and propensity score matching were performed. Results In total, 127 subjects were included in the analysis. Of these, 30 received a ciNPWT dressing and were compared with 97 subjects from a non-study historical control group who had conventional dressing. The overall wound complication rate was 21.3% (27/127). There was no reduction in the rate of wound complications with ciNPWT when compared with conventional dressing [23.3% (7/30) and 20.6% (20/97), respectively, p = 0.75]. In the obese subset (BMI ≥30 kg/m2), there was no significant reduction in wound complications [31.1% (5/16) and 36.8% (7/19), respectively, p = 0.73]. Propensity score matching yielded 26 matched pairs with equivalent rates of wound complications (23.1%, 6/26). Conclusion This is the first reported cohort study evaluating the use of ciNPWT in kidney transplantation. While ciNPWT is safe and well tolerated, it is not associated with a statistically significant reduction in wound complications when compared to conventional dressing. The findings from this study will be used to inform future studies associated with ciNPWT in kidney transplantation.
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Affiliation(s)
- Susanna Lam
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Annie Huynh
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Tracey Ying
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Charbel Sandroussi
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - David Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Henry C. Pleass
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Steve Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Jerome M. Laurence
- Transplantation Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
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Wang C, Li R, Su X, Zhang J, Liu Z. Effect of hydrocolloid dressings on preventing air leakage when applying negative pressure wound therapy to the perineum, buttocks, and sacrococcygeal region. Wound Repair Regen 2024; 32:74-79. [PMID: 38127338 DOI: 10.1111/wrr.13136] [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: 04/23/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 12/23/2023]
Abstract
Maintaining a vacuum when applying negative pressure wound therapy (NPWT) is the key to its function, which is a challenge in the perineum, buttocks, and sacrococcygeal region. A retrospective cohort study was conducted to assess the effect of hydrocolloid dressings on preventing air leakage when applying NPWT in these regions. There were 61 patients in Group A (without the aid of hydrocolloid dressings) and 65 patients in Group B (with the aid of hydrocolloid dressings). The hydrocolloid dressing-assisted NPWT significantly reduced the incidence of air leakage compared with conventional NPWT placement (24.6% vs. 7.7%; risk ratio, 3.20; 95% confidence interval, 1.24-8.27; p = 0.009), while decreasing the number of open NPWT applications (2.2 vs. 1.7; difference, 0.43; 95% confidence interval, 0.19-0.66; p < 0.001), shortening hospital stays (20.1 vs. 16.1; difference, 4.07; 95% confidence interval, 1.68-6.46; p = 0.01), and reducing the incidence of adverse skin events (18.0% vs. 4.6%; risk ratio, 3.91; 95% confidence interval, 1.14-13.34; p = 0.017). These findings support the routine use of hydrocolloid dressing-assisted NPWT placement in the perineum, buttocks, and sacrococcygeal region.
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Affiliation(s)
- Chao Wang
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Rui Li
- Department of Emergency, The Second Hospital of Shandong University, Jinan, China
| | - Xiangpeng Su
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jixun Zhang
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Zhenzhong Liu
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, China
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White SW. Receiving the baton. Aust N Z J Obstet Gynaecol 2023; 63:621-622. [PMID: 37740652 DOI: 10.1111/ajo.13754] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Scott W White
- The Western Australian Centre for Health Research for Women and Babies, The University of Western Australia, Perth, Western Australia, Australia
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, Western Australia, Australia
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Whitty JA, Wagner AP, Kang E, Ellwood D, Chaboyer W, Kumar S, Clifton VL, Thalib L, Gillespie BM. Cost-effectiveness of closed incision negative pressure wound therapy in preventing surgical site infection among obese women giving birth by caesarean section: An economic evaluation (DRESSING trial). Aust N Z J Obstet Gynaecol 2023; 63:673-680. [PMID: 37200473 PMCID: PMC10952760 DOI: 10.1111/ajo.13677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 03/20/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND There is growing evidence regarding the potential of closed incision negative pressure wound therapy (ci-NPWT) to prevent surgical site infections (SSIs) in healing wounds by primary closure following a caesarean section (CS). AIM To assess the cost-effectiveness of ci-NPWT compared to standard dressings for prevention of SSI in obese women giving birth by CS. MATERIALS AND METHODS Cost-effectiveness and cost-utility analyses from a health service perspective were undertaken alongside a multicentre pragmatic randomised controlled trial, which recruited women with a pre-pregnancy body mass index ≥30 kg/m2 giving birth by elective/semi-urgent CS who received ci-NPWT (n = 1017) or standard dressings (n = 1018). Resource use and health-related quality of life (SF-12v2) collected during admission and for four weeks post-discharge were used to derive costs and quality-adjusted life years (QALYs). RESULTS ci-NPWT was associated with AUD$162 (95%CI -$170 to $494) higher cost per person and an additional $12 849 (95%CI -$62 138 to $133 378) per SSI avoided. There was no detectable difference in QALYs between groups; however, there are high levels of uncertainty around both cost and QALY estimates. There is a 20% likelihood that ci-NPWT would be considered cost-effective at a willingness-to-pay threshold of $50 000 per QALY. Per protocol and complete case analyses gave similar results, suggesting that findings are robust to protocol deviators and adjustments for missing data. CONCLUSIONS ci-NPWT for the prevention of SSI in obese women undergoing CS is unlikely to be cost-effective in terms of health service resources and is currently unjustified for routine use for this purpose.
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Affiliation(s)
- Jennifer A. Whitty
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE)CambridgeUK
| | - Adam P. Wagner
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England (EoE)CambridgeUK
| | - Evelyn Kang
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health InstituteGriffith UniversityGold CoastQueenslandAustralia
| | - David Ellwood
- Gold Coast University Hospital, Gold Coast HealthSouthportQueenslandAustralia
- School of Medicine and DentistryGriffith UniversityGold CoastQueenslandAustralia
| | - Wendy Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health InstituteGriffith UniversityGold CoastQueenslandAustralia
| | - Sailesh Kumar
- Mater Mothers’ HospitalUniversity of QueenslandBrisbaneQueenslandAustralia
- Mater Research InstituteUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Vicki L. Clifton
- Mater Research InstituteUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of MedicineIstanbul Aydın UniversityIstanbulTurkey
| | - Brigid M. Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health InstituteGriffith UniversityGold CoastQueenslandAustralia
- Gold Coast University Hospital, Gold Coast HealthSouthportQueenslandAustralia
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Tian Y, Li K, Zeng L. A systematic review with meta-analysis on prophylactic negative pressure wound therapy versus standard dressing for obese women after caesarean section. Nurs Open 2023; 10:5999-6013. [PMID: 37365685 PMCID: PMC10416001 DOI: 10.1002/nop2.1912] [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: 08/31/2022] [Revised: 05/10/2023] [Accepted: 05/29/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS The purpose of this study is to assess the efficacy of prophylactic negative pressure wound therapy (NPWT) in obese women undergoing caesarean section. DESIGN An updated review and meta-analysis of randomized controlled trials following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS PubMed, Embase, Medline, Web of Science, and Cochrane Library were searched from inception up to March 2022 without restriction in language. We chose surgical site infection as the primary outcome. RESULTS NPWT resulted in a lower surgical site infection rate compared with conventional dressing (risk ratio [RR] = 0.76). The infection rate after low transverse incision was lower comparing the NPWT group with the control group ([RR] = 0.76). No statistically significant difference was detected in blistering([RR] = 2.91). The trial sequential analysis did not support the 20% relative decrease in surgical site infection in the NPWT group. (type II error of 20%).
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Affiliation(s)
- Yali Tian
- West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
| | - Ka Li
- West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
| | - Ling Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of NursingSichuan UniversityChengduChina
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Groenen H, Jalalzadeh H, Buis DR, Dreissen YE, Goosen JH, Griekspoor M, Harmsen WJ, IJpma FF, van der Laan MJ, Schaad RR, Segers P, van der Zwet WC, de Jonge SW, Orsini RG, Eskes AM, Wolfhagen N, Boermeester MA. Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis. EClinicalMedicine 2023; 62:102105. [PMID: 37538540 PMCID: PMC10393772 DOI: 10.1016/j.eclinm.2023.102105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023] Open
Abstract
Background The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA). Methods PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995. Findings We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I2 = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis. Interpretation In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence. Funding Dutch Association for Quality Funds Medical Specialists.
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Affiliation(s)
- Hannah Groenen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Hasti Jalalzadeh
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Dennis R. Buis
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Yasmine E.M. Dreissen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
| | - Jon H.M. Goosen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Mitchel Griekspoor
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Wouter J. Harmsen
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Dutch Association of Medical Specialists, Utrecht, Netherlands
| | - Frank F.A. IJpma
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Division of Trauma Surgery, Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Maarten J. van der Laan
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Surgery, University Medical Center Groningen, Groningen, Netherlands
| | - Roald R. Schaad
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Anesthesiology, Leiden University Medical Centre, Leiden, Netherlands
- Dutch Association of Anesthesiology (NVA), Netherlands
| | - Patrique Segers
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Wil C. van der Zwet
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center, Maastricht, Netherlands
| | - Stijn W. de Jonge
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Ricardo G. Orsini
- Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Anne M. Eskes
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Niels Wolfhagen
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
| | - Marja A. Boermeester
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands
- Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands
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Gonzalez MG, Barske ME, Kjellsson KB, Saboda K, Reed HA, Hill MG. Topical negative pressure wound therapy to prevent wound complications following caesarean delivery in high-risk obstetric patients: A randomised controlled trial. Aust N Z J Obstet Gynaecol 2023; 63:516-520. [PMID: 37140175 DOI: 10.1111/ajo.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND AIMS We investigated whether the use of a prophylactic negative pressure wound therapy (NPWT) system in women undergoing caesarean would decrease wound complications in a high-risk population. MATERIALS AND METHODS A randomised controlled trial was performed. Women with risk factors for wound complications undergoing caesarean delivery were randomised to a standard dressing or NPWT placed over their caesarean wound. We standardised the closure of the subcutaneous fat and skin layers, both with Vicryl. Patients were followed for wound complications for up to 6 weeks after their caesareans. The incidence of wound complications was the primary outcome. The single-use NPWT system, PICO, was provided by Smith and Nephew for use in this trial. The trial was registered on clinicaltrials.gov, # NCT03082664. RESULTS We report here on 154 women randomised to either a standard dressing or to the NPWT. Wound complication rates were equivalent between groups, with 19.4 and 19.7% (P = 0.43) of women with follow-up information available experiencing wound complications. CONCLUSION We found no difference in wound complications in women with risk factors treated with a prophylactic NPWT system or standard wound dressing at the time of caesarean birth.
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Affiliation(s)
- Maritza G Gonzalez
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - M Elisa Barske
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - Kristine B Kjellsson
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - Kathylynn Saboda
- Biostatistics and Bioinformatics shared Service, The University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Heather A Reed
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - Meghan G Hill
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
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Zhu Y, Dai L, Luo B, Zhang L. Meta-analysis of prophylactic negative pressure wound therapy for surgical site infections (SSI) in caesarean section surgery. Wideochir Inne Tech Maloinwazyjne 2023; 18:224-234. [PMID: 37680737 PMCID: PMC10481433 DOI: 10.5114/wiitm.2023.125913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/06/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Negative pressure wound therapy (NPWT) has been used in reducing the incidence of surgical site infections (SSIs) and wound complications across various surgical categories. SSIs are a common post-surgical complication following caesarean section (CS) births, making it necessary to use prophylactic interventions to reduce SSI and wound complication incidences. Aim To conduct an updated meta-analysis on randomized controlled trials (RCTs) comparing SSI incidence and wound complications in women undergoing C-sections receiving NPWT or standard dressings after wound closure. Material and methods A systematic literature review was conducted using MEDLINE and CENTRAL databases, and clinical trial registries for RCTs that involved NPWT versus standard dressings in participants undergoing C-section procedures. The primary outcome was surgical site infection (SSI) and other wound complications (haematoma, dehiscence, seroma. Results A total of 11 RCTs were included in the meta-analysis with information from 5,693 patients. A reduction in overall SSI incidence (RR = 0.79, 95% CI: 0.66-0.95, p = 0.01, I2 = 0%) and wound complication rate (RR = 0.86, 0.75 to 0.98, p = 0.02, I2 = 5%) was found with all studies pooled together. Subgroup analyses showed that NPWT did not significantly reduce SSI incidence when stratified by the type of C-section (emergency/elective) whereas the type of NPWT device had a differential effect on SSI reduction, with PICO NPWT systems showing a beneficial effect (RR = 0.72, 0.58 to 0.91, p = 0.006, I2 = 0%) in comparison to the PREVENA closed-incision device (RR = 0.94, 0.68 to 1.29, p = 0.73, I2 = 0%). Conclusions Prophylactic NPWT is useful in reducing the incidence of SSIs in women undergoing C-sections based on synthesis of results from RCTs in obese women (BMI > 30 kg/m2).
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Affiliation(s)
- Yi Zhu
- Department of Burn Plastic Surgery, Taizhou School of Clinical Medicine, Nanjing Medical University. Taizhou City, Jiangsu Province, China
| | - Lingyan Dai
- Ambulatory Surgery Center, Wuhan Children’s Hospital (Wuhan Maternal and Children’s Healthcare Center), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Binjie Luo
- Department of Burn Plastic Surgery, Taizhou School of Clinical Medicine, Nanjing Medical University. Taizhou City, Jiangsu Province, China
| | - Lin Zhang
- Department of Emergency, the First People’s Hospital of Jiangxia District, Wuhan city, Hubei Province, China
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10
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Hamel MS, Tuuli M. Prevention of Postoperative Surgical Site Infection Following Cesarean Delivery. Obstet Gynecol Clin North Am 2023; 50:327-338. [PMID: 37149313 DOI: 10.1016/j.ogc.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Cesarean delivery is the most common major surgical procedure performed among birthing persons in the United States, and surgical-site infection is a significant complication. Several significant advances in preventive measures have been shown to reduce infection risk, while others remain plausible but not yet proven in clinical trials.
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11
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Ligema K. Use of closed incision negative pressure wound therapy on C-section wounds in obese women. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S22-S28. [PMID: 36840522 DOI: 10.12968/bjon.2023.32.4.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Rates of obesity in pregnant women are increasing. Obesity is linked to increased patient risk of developing postoperative wound complications such as surgical site infection, wound dehiscence and haematoma formation. Closed incision negative pressure wound therapy (ciNPWT) has been introduced as a prophylactic intervention to reduce caesarian section (C-section) wound complications. Evidence from randomised controlled trials and retrospective studies has shown variable rates of success in reducing risk of SSI. The studies reviewed in this article found that ciNPWT had no statistically significant impact in reducing rates of wound dehiscence and haematoma formation or increasing long-term satisfaction with the appearance of scar tissue following C-section. Further research into the use of cINPWT to prevent surgical site infection is needed to determine the effectiveness of this therapy in reducing this wound complication.
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Affiliation(s)
- Kaia Ligema
- Community Tissue Viability/Infection Prevention Nurse, Manchester University NHS Foundation Trust, and third-year student MSc Wound Healing and Tissue Repair, Cardiff University
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Wang G, Xu H, Xu G, Zhang H, Li Z, Liu D. Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta‐analysis of randomised controlled trials. Int Wound J 2022; 20:1739-1749. [PMID: 36519410 PMCID: PMC10088847 DOI: 10.1111/iwj.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/09/2022] [Indexed: 12/23/2022] Open
Abstract
Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, -9.31 [-17.54, -1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.
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Affiliation(s)
- Guoqi Wang
- Department of Pediatric The First Medical Center of Chinese PLA General Hospital Beijing China
- Senior Department of Pediatric The Seventh Medical Center of Chinese PLA General Hospital Beijing China
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation Beijing China
| | - Haiyan Xu
- Department of Pharmacy Medical Supplies Center of Chinese PLA General Hospital Beijing China
| | - Gaoxiang Xu
- Department of Orthopedics The First Medical Center of Chinese PLA General Hospital Beijing China
| | - Hao Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation Beijing China
| | - Zhirui Li
- Department of Orthopedics Hainan Hospital of Chinese PLA General Hospital Sanya China
| | - Daohong Liu
- National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation Beijing China
- Senior Department of Orthopedics The Fourth Medical Center of PLA General Hospital Beijing China
- Department of Orthopedics The Eighth Medical Center of PLA General Hospital Beijing China
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Mahomed K, Seeto K, Norton DM, Zhu S. Implementation of an evidence-based bundle to reduce surgical site infection after caesarean section - Review of the interventions. Am J Infect Control 2022; 50:1103-1109. [PMID: 36150794 DOI: 10.1016/j.ajic.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Surgical site infection (SSI) is the most common complication post caesarean section (CS) with a significant impact on women and health services. A bundle approach incorporating previously studied individual interventions has shown increased reductions in SSI. AIM To assess compliance with a SSI intervention bundle and to examine readmission rates for SSI. METHODS A retrospective audit of women who underwent CS at a regional hospital in Queensland, Australia pre-intervention (February 2015-January 2017) and post-intervention (February 2018-December 2020). RESULTS There was good compliance with vaginal cleansing (27.7% vs 84.8%), chlorhexidine skin preparation (90.4% vs 98.4%), BMI-based antibiotic dose adjustment (48.8% vs 74.3%), and Alexis retractor use (9.9% vs 66%), pre and post-implementation periods respectively. There was a reduction in documented hair shaving (2.1% vs 0.5%). There was a trend towards less admission for SSI, a trend that could have been even better had there not been an increasing number of women with high BMI over the years. Fewer cases needed return to theatre post-implementation. Endometritis rates were unchanged. CONCLUSIONS Good compliance can be achieved with good collaboration. There was a reduction in admission rates for SSI. Larger prospective studies are needed to further examine these findings.
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Affiliation(s)
- Kassam Mahomed
- Department of Obstetrics and Gynaecology, Ipswich Hospital, Chelmsford Avenue, Ipswich, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia.
| | - Kimberly Seeto
- Department of Obstetrics and Gynaecology, Ipswich Hospital, Chelmsford Avenue, Ipswich, Queensland, Australia
| | - Dr Madison Norton
- Department of Obstetrics and Gynaecology, Ipswich Hospital, Chelmsford Avenue, Ipswich, Queensland, Australia
| | - Stephanie Zhu
- Department of Obstetrics and Gynaecology, Ipswich Hospital, Chelmsford Avenue, Ipswich, Queensland, Australia
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Gillespie BM, Ellwood D, Thalib L, Kumar S, Mahomed K, Kang E, Chaboyer W. Incidence and risk factors for surgical wound complications in women with body mass index >30 kg/m2 following cesarean delivery: a secondary analysis. AJOG GLOBAL REPORTS 2022; 2:100069. [PMID: 36276792 PMCID: PMC9563898 DOI: 10.1016/j.xagr.2022.100069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND OBJECTIVE STUDY DESIGN RESULTS CONCLUSION
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Emerging Paradigms in the Prevention of Surgical Site Infection: The Patient Microbiome and Antimicrobial Resistance. Anesthesiology 2022; 137:252-262. [PMID: 35666980 PMCID: PMC9558427 DOI: 10.1097/aln.0000000000004267] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This article summarizes new scientific evidence on the pathogenesis of surgical site infection, including the roles of the patient microbiome and antimicrobial resistance, and reviews changes in guidelines and clinical practices for prevention.
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Angarita AM, Jayakumaran J, Di Mascio D, Berghella V. Prophylactic negative pressure wound therapy on wound complications after cesarean delivery in women with obesity: a meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM 2022; 4:100617. [PMID: 35283349 DOI: 10.1016/j.ajogmf.2022.100617] [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: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis of randomized controlled trials aimed to assess whether negative pressure wound therapy affects the rate of wound complications when applied to women with obesity after cesarean delivery compared with standard postoperative dressings. DATA SOURCES This research used PubMed, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials as electronic databases, from the inception of each database to January 2021, with randomized controlled trial as the publication type. There was no restriction applied for language or geographic location. STUDY ELIGIBILITY CRITERIA The selection criteria included only randomized controlled trials comparing the effect of negative pressure wound therapy with that of standard dressings on wound complications in women with obesity undergoing cesarean delivery. METHODS The primary outcome was a wound complication composite outcome (wound infection, separation or dehiscence, hematoma, seroma, or readmission secondary to a wound concern). The wound complication composite was analyzed by counting events once per patient. The summary measures were reported as relative risk or as mean difference with 95% confidence intervals using the random-effects model of DerSimonian and Laird. An I-squared (Higgins I2) value of >0% was used to identify heterogeneity. RESULTS Overall, 11 randomized controlled trials, which included 5746 participants with obesity undergoing cesarean delivery, were included. Of those participants, 2869 (49.9%) were randomized to the intervention group (negative pressure wound therapy), and 2877 (50.1%) were randomized to the control group (standard dressing). Prophylactic negative pressure wound therapy was not associated with a significant change in the rate of wound complications (relative risk, 1.00; 95% confidence interval, 0.81-1.23) compared with standard postoperative dressings. However, the use of negative pressure wound therapy decreased the rate of wound infections (relative risk, 0.79; 95% confidence interval, 0.66- 0.96) and increased the frequency of skin reactions (relative risk, 4.59; 95% confidence interval, 1.29-16.38). Negative pressure wound therapy did not result in a significant difference in the rate of dehiscence, hematoma, seroma, readmission, reoperation, and antibiotic use for wound infection. CONCLUSION Compared with standard postoperative incision dressings, negative pressure wound therapy did not affect the rate of wound complications but decreased the frequency of wound infections when applied to women with obesity after cesarean delivery. However, results should be interpreted with caution, as wound infection outcome includes different definitions per the individual trials. CONDENSATION Prophylactic negative pressure wound therapy has no effect on overall wound complications in women with obesity after cesarean delivery compared with standard dressings.
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Affiliation(s)
- Ana M Angarita
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (Drs Angarita, Jayakumaran, and Berghella)
| | - Jenani Jayakumaran
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (Drs Angarita, Jayakumaran, and Berghella)
| | - Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy (Dr Di Mascio)
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (Drs Angarita, Jayakumaran, and Berghella).
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Norman G, Shi C, Goh EL, Murphy EM, Reid A, Chiverton L, Stankiewicz M, Dumville JC. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev 2022; 4:CD009261. [PMID: 35471497 PMCID: PMC9040710 DOI: 10.1002/14651858.cd009261.pub7] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. OBJECTIVES To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. SEARCH METHODS In January 2021, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. SELECTION CRITERIA We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane risk of bias tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. Our primary outcomes were SSI, mortality, and wound dehiscence. MAIN RESULTS In this fourth update, we added 18 new randomised controlled trials (RCTs) and one new economic study, resulting in a total of 62 RCTs (13,340 included participants) and six economic studies. Studies evaluated NPWT in a wide range of surgeries, including orthopaedic, obstetric, vascular and general procedures. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Eleven studies (6384 participants) which reported mortality were pooled. There is low-certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%) but there is uncertainty around this as confidence intervals include risk of benefits and harm; risk ratio (RR) 0.78 (95% CI 0.47 to 1.30; I2 = 0%). Fifty-four studies reported SSI; 44 studies (11,403 participants) were pooled. There is moderate-certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery; RR 0.73 (95% CI 0.63 to 0.85; I2 = 29%). Thirty studies reported wound dehiscence; 23 studies (8724 participants) were pooled. There is moderate-certainty evidence that there is probably little or no difference in dehiscence between people treated with NPWT (6.62%) and those treated with standard dressing (6.97%), although there is imprecision around the estimate that includes risk of benefit and harms; RR 0.97 (95% CI 0.82 to 1.16; I2 = 4%). Evidence was downgraded for imprecision, risk of bias, or a combination of these. Secondary outcomes There is low-certainty evidence for the outcomes of reoperation and seroma; in each case, confidence intervals included both benefit and harm. There may be a reduced risk of reoperation favouring the standard dressing arm, but this was imprecise: RR 1.13 (95% CI 0.91 to 1.41; I2 = 2%; 18 trials; 6272 participants). There may be a reduced risk of seroma for people treated with NPWT but this is imprecise: the RR was 0.82 (95% CI 0.65 to 1.05; I2 = 0%; 15 trials; 5436 participants). For skin blisters, there is low-certainty evidence that people treated with NPWT may be more likely to develop skin blisters compared with those treated with standard dressing (RR 3.55; 95% CI 1.43 to 8.77; I2 = 74%; 11 trials; 5015 participants). The effect of NPWT on haematoma is uncertain (RR 0.79; 95 % CI 0.48 to 1.30; I2 = 0%; 17 trials; 5909 participants; very low-certainty evidence). There is low-certainty evidence of little to no difference in reported pain between groups. Pain was measured in different ways and most studies could not be pooled; this GRADE assessment is based on all fourteen trials reporting pain; the pooled RR for the proportion of participants who experienced pain was 1.52 (95% CI 0.20, 11.31; I2 = 34%; two studies; 632 participants). Cost-effectiveness Six economic studies, based wholly or partially on trials in our review, assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in five indications: caesarean sections in obese women; surgery for lower limb fracture; knee/hip arthroplasty; coronary artery bypass grafts; and vascular surgery with inguinal incisions. They calculated quality-adjusted life-years or an equivalent, and produced estimates of the treatments' relative cost-effectiveness. The reporting quality was good but the evidence certainty varied from moderate to very low. There is moderate-certainty evidence that NPWT in surgery for lower limb fracture was not cost-effective at any threshold of willingness-to-pay and that NPWT is probably cost-effective in obese women undergoing caesarean section. Other studies found low or very low-certainty evidence indicating that NPWT may be cost-effective for the indications assessed. AUTHORS' CONCLUSIONS People with primary closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSIs than people treated with standard dressings but there is probably no difference in wound dehiscence (moderate-certainty evidence). There may be a reduced risk of death after surgery for people treated with NPWT compared with standard dressings but there is uncertainty around this as confidence intervals include risk of benefit and harm (low-certainty evidence). People treated with NPWT may experience more instances of skin blistering compared with standard dressing treatment (low-certainty evidence). There are no clear differences in other secondary outcomes where most evidence is low or very low-certainty. Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.
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Affiliation(s)
- Gill Norman
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Chunhu Shi
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - En Lin Goh
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Elizabeth Ma Murphy
- Ward 64, St. Mary's Hospital, Manchester Foundation NHS Trust, Manchester, UK
| | - Adam Reid
- School of Biological Sciences, Faculty of Biology, Medicine & Health, Manchester, UK
| | - Laura Chiverton
- NIHR Clinical Research Facility, Great Ormond Street Hospital, London, UK
| | - Monica Stankiewicz
- Chermside Community Health Centre, Community and Oral Health Directorate, Brisbane, Australia
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Chaboyer W, Ellwood D, Thalib L, Kumar S, Mahomed K, Kang E, Gillespie BM. Incidence and predictors of surgical site infection in women who are obese and give birth by elective caesarean section: A secondary analysis. Aust N Z J Obstet Gynaecol 2022; 62:234-240. [PMID: 34506037 DOI: 10.1111/ajo.13428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/23/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical site infection (SSI) after a caesarean section is of concern (CS) is of concern to both clinicians and women themselves. AIMS The aim of this study is to identify the cumulative incidence and predictors of SSI in women who are obese and give birth by elective CS. MATERIALS AND METHODS The method used was planned secondary analysis of data from women with a pre-pregnancy body mass index (BMI) ≥30 kg/m2 giving birth by elective CS in a multicentre randomised controlled trial of a prophylactic closed-incision negative pressure wound therapy dressing. Data were collected from medical records, direct observations of the surgical site and self-reported signs and symptoms from October 2015 to December 2019. The Centers for Disease Control and Prevention definition was used to identify SSI. Women were followed up once in hospital just before discharge and then weekly for four weeks after discharge. Blinded outcome assessors determined SSI. After the cumulative incidence of SSI was calculated, multiple variable logistic regression models were used to identify independent risk factors for SSI. RESULTS SSI incidence in 1459 women was 8.4% (122/1459). Multiple variable-adjusted odds ratios (OR) for SSI were BMI ≥40 kg/m2 (OR 1.55, 95% confidence interval (CI) 1.30-1.86) as compared to BMI 30-34.9 0 kg/m2 , ≥2 previous pregnancies (OR 1.38, 95% CI 1.00-1.80) as compared to no previous pregnancies and pre-CS vaginal cleansing (OR 0.55, 95% CI 0.33-0.99). CONCLUSIONS Our findings may inform preoperative counselling and shared decision-making regarding planned elective CS for women with pre-pregnancy BMI ≥30 kg/m2 .
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Affiliation(s)
- Wendy Chaboyer
- NHMRC Centre of Research Excellence in Wiser Wound Care and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - David Ellwood
- School of Medicine, Griffith University, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Lukman Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - Sailesh Kumar
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Mater Mothers' Hospital, Brisbane, Queensland, Australia
| | - Kassam Mahomed
- Department of Obstetrics and Gynaecology and Faculty of Medicine, University of Queensland, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Evelyn Kang
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Brigid M Gillespie
- NHMRC Centre of Research Excellence in Wiser Wound Care and Menzies Health Institute Queensland & Gold Coast University Hospital, Griffith University, Gold Coast, Queensland, Australia
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Langley-Evans SC, Pearce J, Ellis S. Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: a narrative review. J Hum Nutr Diet 2022; 35:250-264. [PMID: 35239212 PMCID: PMC9311414 DOI: 10.1111/jhn.12999] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
The global prevalence of overweight and obesity in pregnancy is rising and this represents a significant challenge for the management of pregnancy and delivery. Women who have a pre‐pregnancy body mass index greater than 25 kg m–2 are more likely than those with a body mass index in the ideal range (20–24.99 kg m–2) to have problems conceiving a child and are at greater risk of miscarriage and stillbirth. All pregnancy complications are more likely with overweight, obesity and excessive gestational weight gain, including those that pose a significant threat to the lives of mothers and babies. Labour complications arise more often when pregnancies are complicated by overweight and obesity. Pregnancy is a stage of life when women have greater openness to messages about their lifestyle and health. It is also a time when they come into greater contact with health professionals. Currently management of pregnancy weight gain and the impact of overweight tends to be poor, although a number of research studies have demonstrated that appropriate interventions based around dietary change can be effective in controlling weight gain and reducing the risk of pregnancy complications. The development of individualised and flexible plans for avoiding adverse outcomes of obesity in pregnancy will require investment in training of health professionals and better integration into normal antenatal care. Overweight and obesity before pregnancy and excessive gestational weight gain are major determinants of risk for pregnancy loss, gestational diabetes, hypertensive conditions, labour complications and maternal death. Pregnancy is regarded as a teachable moment when women are at their most receptive to messages about their health. However, unclear guidance on diet and physical activity, weight stigma from health professionals, inexperience and reluctance among professionals about raising issues about weight, and stretched resources put the health of women and babies at risk. Excessive weight gain in pregnancy and post‐partum weight retention compromise future fertility and increase risk for future pregnancies. Large randomised controlled trials have had little success in addressing excessive gestational weight gain or antenatal complications. Individualised, culturally sensitive and responsive interventions appear to have greater success.
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Affiliation(s)
- Simon C Langley-Evans
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK
| | - Jo Pearce
- Food & Nutrition Subject Group, Sheffield Hallam University, Sheffield, UK
| | - Sarah Ellis
- School of Biosciences, University of Nottingham, Sutton Bonington, Loughborough, LE12 5RD, UK
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Guo C, Cheng T, Li J. Prophylactic negative pressure wound therapy on surgical site infection in obese women after cesarean section: A systematic review and meta-analysis. Int J Gynaecol Obstet 2021; 158:502-511. [PMID: 34860421 DOI: 10.1002/ijgo.14058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/21/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
Prevention of surgical site infection (SSI) is a public health challenge. The objective of the study was to evaluate the efficacy of negative pressure wound therapy (NPWT) for preventing SSI and other wound complications in obese women undergoing cesarean section. The search terms included "negative pressure wound therapy", "obesity" and "cesarean section/delivery". Randomized controlled trials were used to compare the use of NPWT to standard dressings in preventing SSI in obese women after cesarean section. A comprehensive literature search of four databases was performed up to June 2021. The primary outcome was SSI. Secondary outcomes were seroma, hematoma, overall wound complications, and adverse skin reactions. Ten RCTs involving 5586 patients met the inclusion criteria. The use of NPWT reduced SSI (RR = 0.76, 95%CI: 0.63-0.92, P = 0.004). No statistically significant difference was detected in the incidence of overall wound complications (RR = 0.93, P = 0.48), seroma (RR = 1.10, P = 0.79), hematoma (RR = 0.63, P = 0.36) and hospital readmission (RR = 1.41, P = 0.15). NPWT significantly increased the occurrence of skin blistering with a RR of 4.60 (P = 0.04). Use of prophylactic NPWT after cesarean delivery among obese women is associated with a significant reduction of surgical site infection.
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Affiliation(s)
- Chenchen Guo
- School of Medicine, Southeast University, Nanjing, China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
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Gillespie BM, Thalib L, Ellwood D, Kang E, Mahomed K, Kumar S, Chaboyer W. Effect of negative-pressure wound therapy on wound complications in obese women after caesarean birth: a systematic review and meta-analysis. BJOG 2021; 129:196-207. [PMID: 34622545 DOI: 10.1111/1471-0528.16963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Obesity is associated with increased surgical-site infection (SSI) following caesarean section (CS). OBJECTIVE To summarise the evidence on the effectiveness of negative-pressure wound therapy (NPWT) for preventing SSI and other wound complications in obese women after CS. SEARCH STRATEGY MEDLINE, Embase, CINAHL, Cochrane CENTRAL databases and ClinicalTrials.gov were systematically searched in March 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) of NPWT compared with standard dressings after CS birth. DATA COLLECTION AND ANALYSIS Pooled effect sizes were calculated using either fixed or random effects models based on heterogeneity. The Cochrane risk of bias and Grading of Recommendations Assessment, Development and Evaluation tools were used to assess the quality of studies and overall quality of evidence. MAIN RESULTS Ten RCTs with 5583 patients were included; studies were published between 2012 and 2021. Nine RCTs with 5529 patients were pooled for the outcome SSI. Meta-analysis results suggest a significant difference favouring the NPWT group (relative risk [RR] 0.79, 95% CI 0.65-0.95, P < 0.01), indicating an absolute risk reduction of 1.8% among those receiving NPWT compared with usual care. The risk of blistering in the NPWT group was significantly higher (RR 4.13, 95% CI 1.53-11.18, P = 0.005). All studies had high risk of bias relative to blinding of personnel/participants. Only 40% of studies reported blinding of outcome assessments and 50% had incomplete outcome data. CONCLUSIONS The decision to use NPWT should be considered both in terms of its potential benefits and its limitations. TWEETABLE ABSTRACT NPWT was associated with fewer SSI in women following CS birth but was not effective in reducing other wound complications.
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Affiliation(s)
- B M Gillespie
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University & Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
| | - L Thalib
- Department of Biostatistics, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey
| | - D Ellwood
- Griffith University School of Medicine & Dentistry, and Gold Coast University Hospital, Gold Coast, Qld, Australia
| | - E Kang
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
| | - K Mahomed
- Ipswich Hospital, Ipswich, Qld, Australia
| | - S Kumar
- Mater Research Institute, University of Queensland, Brisbane, Qld, Australia.,Mater Mothers' Hospital, South Brisbane, Qld, Australia
| | - W Chaboyer
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute, Griffith University & Gold Coast Hospital and Health Service, Gold Coast, Qld, Australia
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