Northern Health, Epping, Victoria, Australia.
Northern Health, Epping, Victoria, Australia; Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia.
Surgery. 2022 Sep;172(3):949-954. doi: 10.1016/j.surg.2022.05.020. Epub 2022 Jun 30.
Wound complications are a common cause of postoperative morbidity and incur significant healthcare costs. Recent studies have shown that negative pressure wound dressings reduce wound complication rates, particularly surgical site infections, after elective laparotomies. The clinical utility of prophylactic negative pressure wound dressings for closed emergency laparotomy incisions remains controversial. This meta-analysis investigated the rates of wound complications after emergency laparotomy when a negative pressure wound dressing was applied.
A systematic review and meta-analysis were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Cochrane Registry, Web of Science, and Clinialtrials.gov databases were searched from January 1, 2005, to April 1, 2022. All studies comparing negative pressure wound dressings to standard dressings on closed emergency laparotomy incisions were included.
A total of 1,199 (negative pressure wound dressings: 566, standard dressing: 633) patients from 7 (prospective: 4, retrospective: 3) studies were identified. Overall, the surgical site infection (superficial/deep) rate was 13.6% (77/566) vs 25.1% (159/633) in the negative pressure wound dressing versus standard dressing groups, respectively (odds ratio 0.43, 95% confidence interval 0.30-0.62). Wound breakdown (skin/fascial dehiscence) was significantly lower in the negative pressure wound dressing (7.7%) group compared to the standard dressing (16.9%) group (odds ratio 0.36, 95% confidence interval 0.19-0.72). The incidence of overall wound complications was significantly lower in the negative pressure wound dressing (15.9%) group compared to the standard dressing (30.4%) group (odds ratio 0.41, 95% confidence interval 0.28-0.59). No significant differences were found in hospital length-of-stay and readmission rates.
Prophylactic negative pressure wound dressings for closed emergency laparotomy incisions were associated with a significant reduction in surgical site infections, wound breakdown, and overall wound complications, thus supporting its clinical use.
伤口并发症是术后发病率的常见原因，并导致大量医疗保健费用。最近的研究表明，负压伤口敷料可降低择期剖腹手术后的伤口并发症发生率，尤其是手术部位感染。预防性使用负压伤口敷料预防闭合性急诊剖腹切口的临床效果仍存在争议。本 meta 分析旨在研究使用负压伤口敷料后急诊剖腹切口的伤口并发症发生率。
根据系统评价和 meta 分析的首选报告项目进行系统评价和 meta 分析。检索了 2005 年 1 月 1 日至 2022 年 4 月 1 日期间的 PubMed、Embase、Cochrane 注册中心、Web of Science 和 Clinialtrials.gov 数据库。纳入了比较闭合性急诊剖腹切口使用负压伤口敷料与标准敷料的所有研究。
共纳入 7 项研究（前瞻性 4 项，回顾性 3 项）的 1199 例（负压伤口敷料组 566 例，标准敷料组 633 例）患者。总体而言，手术部位感染（浅表/深部）发生率分别为负压伤口敷料组 13.6%（77/566）和标准敷料组 25.1%（159/633）（比值比 0.43，95%置信区间 0.30-0.62）。负压伤口敷料组的伤口裂开（皮肤/筋膜裂开）发生率明显低于标准敷料组（7.7%对 16.9%）（比值比 0.36，95%置信区间 0.19-0.72）。负压伤口敷料组的总伤口并发症发生率明显低于标准敷料组（15.9%对 30.4%）（比值比 0.41，95%置信区间 0.28-0.59）。两组患者的住院时间和再入院率无显著差异。
闭合性急诊剖腹切口预防性使用负压伤口敷料可显著降低手术部位感染、伤口裂开和总伤口并发症的发生率，支持其临床应用。
