A Single-Use Negative Pressure System Reduces Surgical Site Complications Compared with Conventional Dressings in Closed Surgical Incisions: A Systematic Literature Review with Meta-Analysis

Background: Postoperative surgical site complications (SSCs) represent a significant burden to health-care systems globally. The aim of this study was to determine whether prophylactic use of a single-use negative pressure wound therapy (sNPWT) system* could reduce the incidence of SSCs and the length of hospital stay (LOS) compared with using conventional dressings after closed surgical incisions across different surgical procedures**.

Methods: A systematic literature review (SLR) was performed using PubMed, Embase, and Cochrane library databases. Comparative studies that compared sNPWT to conventional dressings were included with both randomized controlled trials (RCTs) and observational study designs. Meta-analyses were performed using a fixed effect (I2 < 50%) or random effects model (I2 ≥ 50%) depending on statistical heterogeneity. Dichotomous outcomes were reported as odds ratios (OR) and continuous outcomes as mean differences (MD).

Results: The SLR identified 29 relevant studies enrolling 5,614 patients. Odds of surgical site infections were reduced by 63% (odds ratio [OR]: 0.37; 95% confidence interval [CI]: 0.28–0.50; p<0.00001). Odds of wound dehiscence, seroma and necrosis were decreased by 30% (OR: 0.70; 95% CI: 0.53–0.92; p=0.01), 77% (OR: 0.23; 95% CI: 0.11–0.45; p<0.00001), and 89% (OR: 0.11; 95% CI: 0.03–0.39; p=0.0007), respectively. There was a 1.75 day reduction in length of hospital stay in favor of sNPWT (MD: -1.75; 95% CI: -2.69 to -0.81; p=0.0002). There was no statistically significant difference in all other metrics analyzed.

Conclusions: Prophylactic use of the sNPWT device reduced the incidence of SSCs and led to a reduction in the length of hospital stay; this technology therefore warrants consideration by policy makers to optimize postsurgical wound treatment pathways.

*PICO◊, Smith & Nephew Hull, United Kingdom; **Orthopaedic, Colorectal, Plastics/breast, Caesarean section, Cardiothoracic, Vascular