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Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery

Svensson-Björk, R. LU ; Zarrouk, M. LU ; Asciutto, G. LU ; Hasselmann, J. LU and Acosta, S. LU (2020) In British Journal of Surgery 106(4). p.310-318
Abstract


Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery. Methods: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full... (More)


Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery. Methods: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool. Results: Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0·35, 95 per cent c.i. 0·24 to 0·50; P < 0·001). The heterogeneity between the included studies was low (I
2
= 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0·37, 0·22 to 0·63; P < 0·001; I
2
= 0 per cent). Conclusion: Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
British Journal of Surgery
volume
106
issue
4
pages
9 pages
publisher
John Wiley and Sons Inc.
external identifiers
  • pmid:30725478
  • scopus:85061342567
ISSN
0007-1323
DOI
10.1002/bjs.11100
project
Negative pressure wound therapy in closed inguinal incisions after vascular surgery – randomized controlled trials
language
English
LU publication?
yes
id
b599b5da-eb29-4d74-9284-52c6ef412d1f
date added to LUP
2019-02-19 12:20:02
date last changed
2020-10-20 04:40:15
@article{b599b5da-eb29-4d74-9284-52c6ef412d1f,
  abstract     = {<p><br>
                                                         Background: Surgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery. Methods: A study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool. Results: Among 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0·35, 95 per cent c.i. 0·24 to 0·50; P &lt; 0·001). The heterogeneity between the included studies was low (I                             <br>
                            <sup>2</sup><br>
                                                          = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0·37, 0·22 to 0·63; P &lt; 0·001; I                             <br>
                            <sup>2</sup><br>
                                                          = 0 per cent). Conclusion: Incisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.                         <br>
                        </p>},
  author       = {Svensson-Björk, R. and Zarrouk, M. and Asciutto, G. and Hasselmann, J. and Acosta, S.},
  issn         = {0007-1323},
  language     = {eng},
  number       = {4},
  pages        = {310--318},
  publisher    = {John Wiley and Sons Inc.},
  series       = {British Journal of Surgery},
  title        = {Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgery},
  url          = {http://dx.doi.org/10.1002/bjs.11100},
  doi          = {10.1002/bjs.11100},
  volume       = {106},
  year         = {2020},
}