Negative-pressure wound therapy may curb laparotomy infections

Last Updated: 2018-10-04

By David Douglas

NEW YORK (Reuters Health) - Pooled data suggest that prophylactic wound dressings under negative pressure can reduce surgical site infections (SSI) in closed laparotomy incisions, according to researchers in Ireland.

In a paper online September 26 in JAMA Surgery, Dr. Shaheel Mohammad Sahebally of Beaumont Hospital, in Dublin, and colleagues note that numerous studies, mainly in orthopedic and cardiothoracic surgery, have shown a reduction in SSI with negative-pressure wound therapy (NPWT).

To examine the effect in closed laparotomy incisions performed for general and colorectal surgery, the researchers conducted a systematic review and meta-analysis of data from nine studies involving 1,266 patients. Three of the studies were randomized trials.

On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio, 0.25). In addition, using sensitivity analysis focusing solely on colorectal procedures, NPWT also significantly reduced SSI rates (pooled OR, 0.16).

However, there was no difference in the rates of seroma or wound dehiscence.

These findings, say the researchers, "must be construed with caution, however, because the studies have significant clinical heterogeneity." In particular, different devices with different pressure settings and different periods of application were employed across the studies.

Dr. Sahebally told Reuters Health by email that given the apparent risk reduction with NPWT in general and colorectal surgery, its "use in this setting should be considered."

He added, "further research is needed to determine which specific wound category . . . and what clinical setting (elective versus emergency surgery) NPWT has the greatest benefits upon."

Dr. Harvey Himel, a plastic and reconstructive surgeon at Mount Sinai Hospital in New York, told Reuters Health by email, "This study is an encouraging first step in assessing this popular but comparatively expensive technology in the search for ways to decrease wound infection after colorectal surgery."

"The authors mention two randomized trials that are currently underway and that may help bolster (their) conclusions," said Dr. Himel, who was not involved in the study.

The authors also suggest that "a cost savings of 15% as a result of the expected rate of infection prevention would balance the added expense of this postoperative treatment. It would be helpful if this cost estimate could be confirmed by an economic analysis of the clinical outcome from the two clinical trials in progress."

SOURCE: https://bit.ly/2O4Y9vB

JAMA Surg 2018.