Global Clinical Affairs, Smith+Nephew, Hull, UK.
Health Economics and Market Access, Smith+Nephew, Hull, UK.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa003.
Surgical-site complications (SSCs) remain a significant cause of morbidity and mortality, particularly in high-risk patients. The aim of this study was to determine whether prophylactic use of a specific single-use negative-pressure wound therapy (sNPWT) device reduced the incidence of SSCs after closed surgical incisions compared with conventional dressings.
A systematic literature review was performed using MEDLINE, Embase and the Cochrane Library to identify articles published from January 2011 to August 2018. RCTs and observational studies comparing PICO™ sNPWT with conventional dressings, with at least 10 patients in each treatment arm, were included. Meta-analyses were performed to determine odds ratios (ORs) or mean differences (MDs), as appropriate. PRISMA guidelines were followed. The primary outcome was surgical-site infection (SSI). Secondary outcomes were other SSCs and hospital efficiencies. Risk of bias was assessed.
Of 6197 citations screened, 29 studies enrolling 5614 patients were included in the review; all studies included patients with risk factors for SSCs. sNPWT reduced the number of SSIs (OR 0.37, 95 per cent c.i. 0.28 to 0.50; number needed to treat (NNT) 20). sNPWT reduced the odds of wound dehiscence (OR 0.70, 0.53 to 0.92; NNT 26), seroma (OR 0.23, 0.11 to 0.45; NNT 13) and necrosis (OR 0.11, 0.03 to 0.39; NNT 12). Mean length of hospital stay was shorter in patients who underwent sNPWT (MD -1.75, 95 per cent c.i. -2.69 to -0.81).
Use of the sNPWT device in patients with risk factors reduced the incidence of SSCs and the mean length of hospital stay.
手术部位并发症（SSC）仍然是发病率和死亡率的重要原因，尤其是在高危患者中。本研究旨在确定与常规敷料相比，在闭合性手术切口后预防性使用特定的一次性负压伤口治疗（sNPWT）装置是否会降低 SSC 的发生率。
使用 MEDLINE、Embase 和 Cochrane 图书馆系统地检索了从 2011 年 1 月至 2018 年 8 月发表的文章。纳入了比较 PICO™ sNPWT 与常规敷料的 RCTs 和观察性研究，每个治疗组至少有 10 名患者。适当时进行了荟萃分析以确定比值比（OR）或平均差异（MD）。遵循 PRISMA 指南。主要结局是手术部位感染（SSI）。次要结局是其他 SSCs 和医院效率。评估了偏倚风险。
在筛选出的 6197 条引文中，有 29 项研究共纳入了 5614 名患者，纳入了综述；所有研究均纳入了 SSC 风险因素患者。sNPWT 减少了 SSI 的数量（OR 0.37，95%置信区间 0.28 至 0.50；需要治疗的人数（NNT）为 20）。sNPWT 降低了伤口裂开（OR 0.70，0.53 至 0.92；NNT 26）、血清肿（OR 0.23，0.11 至 0.45；NNT 13）和坏死（OR 0.11，0.03 至 0.39；NNT 12）的几率。接受 sNPWT 的患者的平均住院时间更短（MD-1.75，95%置信区间-2.69 至-0.81）。
在有风险因素的患者中使用 sNPWT 装置可降低 SSC 的发生率和平均住院时间。
