Negative pressure wound therapy for closed incisions in orthopedic trauma surgery: a meta-analysis

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Abstract

Background

This meta-analysis was performed to determine the efficacy of negative pressure wound therapy (NPWT) versus conventional wound dressings for closed incisions in orthopedic trauma surgery.

Methods

A systematic search was performed in PubMed, Embase, and the Cochrane Library databases. The outcome measures included deep surgical site infection (SSI), superficial SSI; wound dehiscence and length of hospital stay. Cochrane collaboration’s tool and the Newcastle–Ottawa Scale (NOS) were used to evaluate literature qualities. Meta-analysis was performed using RevMan 5.3 software.

Results

A total of 6 studies including 2 randomized controlled trials (RCTs) and 4 cohort studies met our inclusion criteria. NPWT resulted in a significantly lower incidence of deep SSI, superficial SSI, and wound dehiscence than conventional wound dressings. However, no statistically significant difference was found in the length of hospital stay.

Conclusions

NPWT appeared to be an efficient alternative to help prevent SSIs and wound dehiscence on closed incisions in orthopedic trauma surgery. Rational use of NWPT should be based on the presence of patient’s condition and risk factors.

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Most cited references 24

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The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost.

K Kirkland, D Sexton, Andrea Richardson … (2002)

To measure the impact of orthopedic surgical-site infections (SSIs) on quality of life, length of hospitalization, and cost. A pairwise-matched (1:1) case-control study within a cohort. A tertiary-care university medical center and a community hospital. Cases of orthopedic SSIs were prospectively identified by infection control professionals. Matched controls were selected from the entire cohort of patients undergoing orthopedic surgery who did not have an SSI. Matching variables included type of surgical procedure, National Nosocomial Infections Surveillance risk index, age, date of surgery, and surgeon. Quality of life, duration of postoperative hospital stay, frequency of hospital readmission, overall direct medical costs, and mortality rate. Fifty-nine SSIs were identified. Each orthopedic SSI accounted for a median of 1 extra day of stay during the initial hospitalization (P = .001) and a median of 14 extra days of hospitalization during the follow-up period (P = .0001). Patients with SSI required more rehospitalizations (median, 2 vs 1; P = .0001) and more total surgical procedures (median, 2 vs 1; P = .0001). The median total direct cost of hospitalizations per infected patient was $24,344, compared with $6,636 per uninfected patient (P = .0001). Mortality rates were similar for cases and controls. Quality of life was adversely affected for patients with SSI. The largest decrements in scores on the Medical Outcome Study Short Form 36 questionnaire were seen in the physical functioning and role-physical domains. Orthopedic SSIs prolong total hospital stays by a median of 2 weeks per patient, approximately double rehospitalization rates, and increase healthcare costs by more than 300%. Moreover, patients with orthopedic SSIs have substantially greater physical limitations and significant reductions in their health-related quality of life.

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Incisional negative pressure wound therapy after high-risk lower extremity fractures.

Thomas Moore, Gerald McGwin, James Stannard … (2011)

To investigate negative pressure wound therapy (NPWT) to prevent wound dehiscence and infection after high-risk lower extremity trauma. Prospective randomized multicenter clinical trial. Four Level I trauma centers. Blunt trauma patients with one of three high-risk fracture types (tibial plateau, pilon, calcaneus) requiring surgical stabilization. Incisional NPWT (Group B) was applied to the closed surgical incisions of patients randomized to the study arm of this trial, whereas standard postoperative dressings (Group A) were applied to the control patients. Acute and chronic wound dehiscence and infection. Two hundred forty-nine patients with 263 fractures have enrolled in this study with 122 randomized to Group A (controls) and 141 to Group B (NPWT). There was no difference between the groups in the distribution of calcaneus (39%), pilon (17%), or tibial plateau (44%) fractures. There were a total of 23 infections in Group A and 14 in Group B, which represented a significant difference in favor of NPWT (P = 0.049). The relative risk of developing an infection was 1.9 times higher in control patients than in patients treated with NPWT (95% confidence interval, 1.03-3.55). There have been no studies evaluating incisional NPWT as a prophylactic treatment to prevent infection and wound dehiscence of high-risk surgical incisions. Our data demonstrate that there is a decreased incidence of wound dehiscence and total infections after high-risk fractures when patients have NPWT applied to their surgical incisions after closure. There is also a strong trend for decreases in acute infections after NPWT. Based on our data in this multicenter prospective randomized clinical trial, NPWT should be considered for high-risk wounds after severe skeletal trauma.

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Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty.

Milena Pachowsky, S Lehrl, Philipp Schlechtweg … (2012)

The purpose of this study was to evaluate the use of negative pressure wound therapy (NPWT) to improve wound healing after total hip arthroplasty (THA) and its influence on the development of postoperative seromas in the wound area. The study is a prospective randomised evaluation of NPWT in patients with large surgical wounds after THA, randomising patients to either a standard dressing (group A) or a NPWT (group B) over the wound area. The wound area was examined with ultrasound to measure the postoperative seromas in both groups on the fifth and tenth postoperative days. There were 19 patients randomised in this study. Ten days after surgery, group A (ten patients, 70.5 ± 11.01 years of age) developed seromas with an average size of 5.08 ml and group B (nine patients, 66.22 ± 17.83 years of age) 1.97 ml. The difference was significant (p = 0.021). NPWT has been used on many different types of traumatic and non traumatic wounds. This prospective, randomised study has demonstrated decreased development of postoperative seromas in the wound and improved wound healing.

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Author and article information

Contributors

Hao Qu: email@zju.edu.cn

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 11 December 2019

Publication date PMC-release: 11 December 2019

Publication date Collection: 2019

Volume: 14

Electronic Location Identifier: 427

Affiliations

[1 ]ISNI 0000 0004 1759 700X, GRID grid.13402.34, Department of Orthopaedic Surgery, The Second Affiliated Hospital, , Zhejiang University School of Medicine, ; Hangzhou, 310009 People’s Republic of China

[2 ]ISNI 0000 0004 1759 700X, GRID grid.13402.34, Operating Room, The Second Affiliated Hospital, , Zhejiang University School of Medicine, ; Hangzhou, 310009 People’s Republic of China

Article

Publisher ID: 1488

DOI: 10.1186/s13018-019-1488-z

PMC ID: 6907184

PubMed ID: 31829217

SO-VID: ebadbf37-a8fc-4b50-95df-279ec4c29ad8

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 14 October 2019

Date accepted : 26 November 2019

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004731, Natural Science Foundation of Zhejiang Province;

Award ID: LQ19H060003

Award Recipient : Cong Wang

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: negative pressure wound therapy,conventional wound dressings,surgical site infection,closed incisions,orthopaedic trauma,meta-analysis

Data availability:

ScienceOpen disciplines: Surgery

Keywords: negative pressure wound therapy, conventional wound dressings, surgical site infection, closed incisions, orthopaedic trauma, meta-analysis

Negative pressure wound therapy for closed incisions in orthopedic trauma surgery: a meta-analysis

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Abstract

Background

Methods

Results

Conclusions

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