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Meta-Analysis to Compare Outcomes of Two Different Negative Pressure Therapy Systems for Closed Incision Management in Knee and Hip Arthroplasty
Introduction: Closed incision negative pressure therapy (ciNPT) to aid in the reduction of incisional risks have been incorporated into the practice of diverse surgical specialties.1-6 Commercially-available systems deliver ciNPT through a variety of different mechanisms.
The purpose of this meta-analysis is to compare potential effects of these differences on clinical outcomes following hip and knee arthroplasty.
Methods: A systematic literature search was conducted to identify hip and knee arthroplasty studies that compared the effect of two ciNPT systems against standard of care (SOC) on the incidence of surgical site complications (SSCs) and surgical site infections (SSI). Meta-analyses were executed by calculating risk ratios using a random effects model to assess the effect of (1) closed incision negative pressure therapy with foam dressing (ciNPT-F*) versus SOC and (2) ciNPT with multilayer absorbent dressing (ciNPT-MLA†) versus SOC. Comprehensive Meta-Analysis Version 3.0 (Biostat Inc., Englewood, NJ) software performed analyses.
Results: Twelve studies comparing ciNPT-F to SOC and 6 studies comparing ciNPT-MLA to SOC were identified. For ciNPT-F, 8 of 12 studies reported SSC rates. In those, ciNPT-F significantly reduced the incidence of SSC (RR = .332, 95% CI = .236, .467; p < .001). For ciNPT-MLA, 5 of 6 studies reported SSC rates. In those, there was no significant difference in SSC rates between ciNPT-MLA or SOC (RR = .798, 95% CI = .458, 1.398; p = .425). Additionally, SSIs rates were assessed in 7 of 12 studies involving ciNPT-F. In those, ciNPT-F significantly reduced the incidence of SSI (RR = .401, 95% CI = .190, .844; p = .016). For ciNPT-MLA, 4 of 6 studies reported SSI rates. In those, ciNPT-MLA versus SOC there was no significant difference in SSI rates between ciNPT-MLA or SOC (RR = .580, 95% CI = .222, 1.513; p = .265).
Discussion: In these meta-analyses, ciNPT-F demonstrated a statistically significant reduction in the incidence of SSCs and SSIs when assessed against SOC. Conversely, ciNPT-MLA did not demonstrate significantly different rates of SSCs and SSIs when compared to SOC. Reasons for these observed differences were not evaluated as part of this study.
References
1. Cooper HJ, Roc GC, Bas MA, et al. Closed incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee. Injury. 2018;49(2):386-391.
2. Ruggieri VG, Olivier ME, Aludaat C, et al. Negative Pressure versus Conventional Sternal Wound Dressing in Coronary Surgery Using Bilateral Internal Mammary Artery Grafts. Heart Surg Forum. 2019;22(2):E092-E096.
3. Licari L, Campanella S, Carolla C, Viola S, Salamone G. Closed Incision Negative Pressure Therapy Achieves Better Outcome Than Standard Wound Care: Clinical Outcome and Cost-Effectiveness Analysis in Open Ventral Hernia Repair With Synthetic Mesh Positioning. Cureus. 2020;12(5):e8283.
4. Swift SH, Zimmerman MB, Hardy-Fairbanks AJ. Effect of single-use negative pressure wound therapy on postcesarean infections and wound complications for high-risk patients. J Reprod Med. 2015;60(5-6):211-218.
5. Ferrando PM, Ala A, Bussone R, Beramasco L, Actis Perinetti F, Malan F. Closed Incision Negative Pressure Therapy in Oncological Breast Surgery: Comparison with Standard Care Dressings. Plastic and Reconstructive Surgery - Global Open. 2018;6(6):e1732.
6. Pleger SP, Nink N, Elzien M, Kunold A, Koshty A, Boning A. Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single-institution study. Int Wound J. 2018;15(1):75-83.
Trademark
*3M™ Prevena™ Incision Management System (3M Company; St. Paul, MN); PICO◊ Single Use Negative Pressure Wound Therapy System (Smith+Nephew, Watford, England, UK)
