Negative Pressure Wound Therapy on surgical incisions for Patients Post-Surgery

Key Message

Overall, the identified evidence suggested that the -125 mmHg negative pressure wound therapy (NPWT) system is statistically significantly more effective than conventional wound dressing for preventing surgical site infections (SSI), though some studies showed no difference. However, results from a systematic review subgroup analysis indicated that the difference in SSI incidence between the NPWT and standard dressing groups reached the level of significance only in patients who had superficial SSI (Szilagyi I). Due to conflicting results from the included studies, there was no conclusive evidence indicating that a -125 mmHg negative pressure wound therapy (NPWT) system is statistically significantly more effective than conventional wound dressing for reducing the rate of reoperation and readmissions due to wound complications, or reducing the duration of postoperative stay in hospital or the intensive care unit. Evidence of limited quality suggested that at the time of discharge after surgery, patients’ health-related quality of life (HRQoL) may be significantly better with NPWT than standard wound dressing. However, there was no statistically significant difference in HRQoL scores at the 6-week follow-up assessment. The difference in mortality rate between the two groups was not statistically significant, and the causes of death were not reported. The evidence concerning non-SSI outcomes was limited in quality due to study design and methodological limitations such as open-label randomized controlled trials with unclear exclusion criteria, suboptimal randomization processes, and high patient dropout rate. Furthermore, most of the studies had inherently higher risk of systemic biases because they were non-randomized and lacked the risk-diminishing property of randomization.The literature search for this review did not identify any relevant evidence regarding the cost-effectiveness of using a -125 mm Hg negative pressure wound therapy device; therefore, no summary can be provided.The evidence-based guideline recommends that surgeons assess individual patients’ risk factors and surgical risks and consider using negative pressure wound therapy for patients at high risk for developing surgical site occurrences, or who are undergoing a high-risk procedure, or a procedure that would have highly morbid consequences if a surgical site infection occurred. The strength of the recommendation and the specific evidence supporting it were not provided. However, the authors indicate that evidence for the guideline came from 100 publications, including systematic reviews, randomized controlled trials, and non-randomized studies.