Meta-Analysis of Closed-Incision Negative Pressure Wound Therapy for Vascular Surgery Groin Wounds

Abstract

Our aim was to perform a comprehensive, updated meta-analysis of closed incision negative pressure wound therapy (ciNPWT) for vascular surgery groin wounds after the largest multicenter randomized controlled trial (RCT) on the subject to date reported no clinical benefit. A systematic review identified eight RCTs that compared the incidence of postoperative surgical site infection (SSI) of vascular surgical groin incisions treated with ciNPWT vs standard dressings. The secondary outcomes included dehiscence, seroma, lymph leak, hematoma, reoperation, and readmission. Odds ratios (ORs) were combined across studies using random effects meta-analysis. The risk of bias was assessed using the Cochrane risk of bias tool, Harbord test, and trim-and-fill analysis. Eight RCTs, with 1125 incisions (ciNPWT, n = 555; 49.3%; controls, n = 570; 50.7%), were included. The RCTs included three studies inside and five studies outside the United States. ciNPWT was associated with a significant reduction in the rate of SSIs (OR, 0.39; 95% confidence interval [CI], 0.24-0.63; P < .001; Fig). No significant difference was found in the rate of dehiscence (OR, 1.11; 95% CI, 0.67-1.83; P = .68); the incidence of seroma, lymph leak, or hematoma (OR, 0.49; 95% CI, 0.13-1.76; P = .27); readmission (OR, 0.60; 95% CI, 0.30-1.21; P = .15); or reoperation (OR, 0.68; 95% CI, 0.40-1.16; P = .16). The risk of bias assessment identified a high risk of bias regarding participant blinding in all eight studies, a low risk for randomization and outcome reporting, and variability between studies for other methods (Table). No evidence of publication bias was found. A meta-analysis of pooled data suggested prophylactic use of ciNPWT for vascular groin incisions is associated with reduced rates of SSIs. However, its clinical benefit should be evaluated in the context of institutional rates of SSIs using traditional dressings.TableRisk of biasInvestigatorRandom sequence generationAllocation concealmentBlinding of participantsBlinding of outcome assessmentIncomplete outcomes dataSelective reportingOther; COISabat, 2016UnclearUnclearHighUnclearHighHighUnclearLee, 2017LowLowHighLowLowHighHighEngelhardt, 2018LowUnclearHighUnclearLowUnclearUnclearKwon, 2018LowUnclearHighHighLowUnclearLowPleger, 2018UnclearUnclearHighUnclearLowUnclearHighGombert, 2018LowUnclearHighHighHighHighHighHasselmann, 2019LowHighHighLowLowLowHighBertges, 2021LowUnclearHighHighLowLowHighCOI, Conflicts of interest. Open table in a new tab