Prophylactic negative pressure wound therapy for surgical site infection in obese women undergoing cesarean section: an evidence synthesis with trial sequential analysis

Abstract

Objective Current evidence for negative pressure wound therapy (NPWT) on surgical site infection (SSI) and wound complications in cesarean section is conflicting. The objective of this study was to evaluate the efficacy of prophylactic NPWT for preventing SSI and other wound complications in obese women undergoing cesarean section (CS). Methods We systematically searched PubMed, Embase, the Cochrane Library and clinicaltTrial.gov to identify randomized controlled trials (RCTs) that compared NPWT with standard dressing for cesarean section. The primary outcome was SSI. Secondary outcomes were overall wound complications and hospital readmission. Risk ratio (RR) with 95% confidence intervals (CIs) was calculated using random-effects models. Review Manager 5.3 was applied to analyze the collected data. Results Eight RCTs involving 1972 patients were included in this meta-analysis. The pooled results showed that the risk of SSI was significantly lower with the use of NPWT when compared with standard dressing (RR = 0.68, 95%CI = 0.51–0.90, p = .008). However, there was no difference in overall wound complications (RR = 0.93, 95%CI = 0.74–1.17, p = 0.52) and hospital readmission (RR = 1.03, 95%CI = 0.67–1.60, p = .89) between two groups. Current evidence was not confirmed by trial sequential analysis. Conclusion On the basis of our findings, NPWT decreases the risk of SSI after cesarean section in obese women after CS, despite this approach does not reduce the overall wound complications and hospital readmission. However, further RCTs are needed to make conclusive evidence.