Smid Marcela C, Dotters-Katz Sarah K, Grace Matthew, Wright Sarah T, Villers Margaret S, Hardy-Fairbanks Abbey, Stamilio David M
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.
Obstet Gynecol. 2017 Nov;130(5):969-978. doi: 10.1097/AOG.0000000000002259.
To summarize available studies on wound complication outcomes after prophylactic negative pressure wound therapy for obese women (body mass index 30 or greater).
We conducted a systematic review and meta-analysis using electronic database search (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Google scholar, and Web of Science), Cochrane, and trial registries including ClinicalTrials.gov.
We conducted an electronic search of research articles from 1966 to January 2017 for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies of negative pressure wound therapy compared with standard dressing after cesarean delivery among obese women. Our primary outcome was defined as a composite of wound complication, including wound or surgical site infection, cellulitis, seroma, hematoma, wound disruption, or dehiscence. For cohort studies and RCTs, we performed a descriptive systematic review. For available RCTs, we performed a meta-analysis and pooled risk ratios using a random-effects model. We assessed for heterogeneity using χ test for heterogeneity and I test. We assessed for publication bias using a funnel plot.
TABULATION, INTEGRATION, AND RESULTS: Of 10 studies meeting eligibility criteria, five were RCTs and five were cohort studies. Results of cohort studies were varied; however, all had a high potential for selection bias. In the meta-analysis, there was no difference in primary composite outcome among those women with negative pressure wound therapy (16.8%) compared with those who had standard dressing (17.8%) (risk ratio 0.97, 95% CI 0.63-1.49). There was no statistically significant heterogeneity (χ test 4.80, P=.31, I=17%).
Currently available evidence does not support negative pressure wound therapy use among obese women for cesarean wound complication prevention.
PROSPERO: International prospective register of systematic reviews, 42016033948.
总结关于肥胖女性（体重指数30或更高）预防性负压伤口治疗后伤口并发症结局的现有研究。
我们通过电子数据库检索（PubMed、护理及相关健康文献累积索引、EMBASE、谷歌学术和科学网）、Cochrane以及包括ClinicalTrials.gov在内的试验注册库进行了系统评价和荟萃分析。
我们对1966年至2017年1月的研究文章进行了电子检索，以查找肥胖女性剖宫产术后负压伤口治疗与标准敷料相比的随机对照试验（RCT）、前瞻性队列研究和回顾性队列研究。我们的主要结局定义为伤口并发症的综合指标，包括伤口或手术部位感染、蜂窝织炎、血清肿、血肿、伤口裂开或切口裂开。对于队列研究和RCT，我们进行了描述性系统评价。对于可用的RCT，我们进行了荟萃分析并使用随机效应模型汇总风险比。我们使用异质性χ检验和I²检验评估异质性。我们使用漏斗图评估发表偏倚。
制表、整合与结果：在符合纳入标准的10项研究中，5项为RCT，5项为队列研究。队列研究的结果各不相同；然而，所有研究都有很高的选择偏倚可能性。在荟萃分析中，接受负压伤口治疗的女性（16.8%）与接受标准敷料的女性（17.8%）相比，主要综合结局无差异（风险比0.97，95%可信区间0.63 - 1.49）。无统计学显著异质性（χ检验4.80，P = 0.31，I² = 17%）。
目前可得的证据不支持肥胖女性使用负压伤口治疗来预防剖宫产伤口并发症。
PROSPERO：国际前瞻性系统评价注册库，42016033948。
