Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis.

摘要: Importance Surgical site infections (SSIs) are common after laparotomy wounds and associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. Objective To evaluate the association prophylactic NPWT SSI rates in incisions performed for general colorectal surgery elective emergency settings. Data Sources PubMed, Embase, Cochrane Central Register Controlled Trials, Google Scholar databases were searched without language restrictions relevant articles from inception until December 2017. latest search was on 31, bibliographies retrieved studies further screened potential additional studies. Study Selection Randomized clinical trials nonrandomized included. Unpublished reports excluded, as that examined (or standard nonpressure) dressings only comparator group. Studies evaluated open abdominal also excluded. Disagreement resolved by discussion, if question remained unsettled, opinion senior author sought. A total 198 citations identified, 189 Extraction Synthesis This meta-analysis conducted according PRISMA guidelines. independently extracted 2 authors. random-effects model used statistical analysis. Main Outcomes Measures primary outcome measure SSI, secondary outcomes included seroma dehiscence rates. These chosen before data collection. Results Nine unique (3 randomized prospective 4 retrospective studies) capturing 1266 patients Of these, 1187 1189 final analysis (52.3% male among 7 reporting sex; mean [SD] age, 52 [15] years 8 age). Significant methodologic heterogeneity existed On analysis, significantly lower rate compared (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52;P  Conclusions Relevance Application is reduced but similar conventional nonpressure dressings.