scholarly journals Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials

2020 ◽  
Author(s):  
Patrick Anthony Boland ◽  
Michael E. Kelly ◽  
Noel E. Donlon ◽  
Jarlath C. Bolger ◽  
Brian J. Mehigan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Negative Pressure ◽  
Randomised Controlled Trials ◽  
Negative Pressure Wound Therapy ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Wound Therapy ◽  
Randomised Controlled

scholarly journals Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Yvonne Zens ◽  
Michael Barth ◽  
Heiner C. Bucher ◽  
Katrin Dreck ◽  
Moritz Felsch ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Publication Bias ◽  
Randomised Controlled Trials ◽  
Wound Closure ◽  
Negative Pressure Wound Therapy ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Wound Therapy ◽  
Secondary Intention ◽  
Randomised Controlled

Abstract Background Negative pressure wound therapy (NPWT) is a widely used method of wound treatment. We performed a systematic review of randomised controlled trials (RCTs) comparing the patient-relevant benefits and harms of NPWT with standard wound therapy (SWT) in patients with wounds healing by secondary intention. Methods We searched for RCTs in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: July 2018) and screened reference lists of relevant systematic reviews and health technology assessments. Manufacturers and investigators were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome (e.g. wound closure). We assessed publication bias and, if feasible, performed meta-analyses, grading the results into different categories (hint, indication or proof of a greater benefit or harm). Results We identified 48 eligible studies of generally low quality with evaluable data for 4315 patients and 30 eligible studies with missing data for at least 1386 patients. Due to potential publication bias (proportion of inaccessible data, 24%), we downgraded our conclusions. A meta-analysis of all wound healing data showed a significant effect in favour of NPWT (OR 1.56, 95% CI 1.15 to 2.13, p = 0.008). As further analyses of different definitions of wound closure did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. A meta-analysis of hospital stay (in days) showed a significant difference in favour of NPWT (MD − 4.78, 95% CI − 7.79 to − 1.76, p = 0.005). As further analyses of different definitions of hospital stay/readmission did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. There was neither proof (nor indication nor hint) of greater benefit or harm of NPWT for other patient-relevant outcomes such as mortality and adverse events. Conclusions In summary, low-quality data indicate a greater benefit of NPWT versus SWT for wound closure in patients with wounds healing by secondary intention. The length of hospital stay is also shortened. The data show no advantages or disadvantages of NPWT for other patient-relevant outcomes. Publication bias is an important problem in studies on NPWT, underlining that all clinical studies need to be fully reported.

scholarly journals 388 Controlling the Controls: What Is Negative Pressure Wound Therapy Compared to In Clinical Trials?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H McMillan ◽  
U Vo ◽  
T Richards
Keyword(s):  
Surgical Site Infection ◽  
Negative Pressure ◽  
Randomised Controlled Trials ◽  
Negative Pressure Wound Therapy ◽  
Standard Of Care ◽  
Controlled Trials ◽  
Site Infection ◽  
Wound Therapy ◽  
Mapping Review ◽  
Randomised Controlled

Abstract Aim Closed incision negative pressure wound therapy (ciNPWT) appears to reduce surgical site infection (SSI). However, randomised controlled trials have compared to ‘standard wound care’ but there appears no standard and care is variable. The aim of this review was to assess the control arms compared in trials of ciNPWT for potential confounding variables that could influence the rates of SSI and therefore the trial outcomes. Method A mapping review of the PubMed database was undertaken in the English language for randomised controlled trials comparing use of ciNPWT to alternative dressings on closed surgical wounds and with surgical site infection as an outcome. Data regarding ciNPWT duration and frequency of change were documented. In the comparator arm potential factors that may influence SSI rates were reviewed including method of wound closure, control dressing type and frequency of change and patient washing were extracted. Results 27 studies were included in the mapping review. Most studies did not control for skin closure method or consider differences in patient showering. There was heterogeneity in terms of ciNPWT duration and whether this was changed. There was little control in the comparator arms. A variety of control dressings were compared and overall, these were changed more frequently than the ciNPWT dressing in most studies. No ‘standard of care’ was apparent. Conclusions In randomised trials of ciNPWT there was no control over ‘standard of care’ comparison dressings. Various potential confounders could influence SSI rates. Future studies should aim to control the controls when assessing the efficacy of ciNPWT for SSI prevention.

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