دورية أكاديمية
أعرض في EDS

Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis.

التفاصيل البيبلوغرافية
العنوان: Incisional negative pressure wound therapy for the prevention of surgical site infection: an up-to-date meta-analysis and trial sequential analysis.
المؤلفون: Groenen H; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands., Jalalzadeh H; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands., Buis DR; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands., Dreissen YEM; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Department of Neurosurgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands., Goosen JHM; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, Netherlands., Griekspoor M; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Dutch Association of Medical Specialists, Utrecht, Netherlands., Harmsen WJ; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Dutch Association of Medical Specialists, Utrecht, Netherlands., IJpma FFA; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Division of Trauma Surgery, Department of Surgery, University Medical Center Groningen, Groningen, Netherlands., van der Laan MJ; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Department of Surgery, University Medical Center Groningen, Groningen, Netherlands., Schaad RR; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Department of Anesthesiology, Leiden University Medical Centre, Leiden, Netherlands.; Dutch Association of Anesthesiology (NVA), Netherlands., Segers P; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands., van der Zwet WC; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.; Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Maastricht University Medical Center, Maastricht, Netherlands., de Jonge SW; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands., Orsini RG; Department of Surgery, Maastricht University Medical Center+, Maastricht, Netherlands., Eskes AM; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands.; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia., Wolfhagen N; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands., Boermeester MA; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, Netherlands.; Amsterdam Gastroenterology Endocrinology & Metabolism, Amsterdam, Netherlands.; Dutch National Guideline Group for Prevention of Postoperative Surgical Site Infections, Netherlands.
المصدر: EClinicalMedicine [EClinicalMedicine] 2023 Jul 24; Vol. 62, pp. 102105. Date of Electronic Publication: 2023 Jul 24 (Print Publication: 2023).
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: The Lancet Country of Publication: England NLM ID: 101733727 Publication Model: eCollection Cited Medium: Internet ISSN: 2589-5370 (Electronic) Linking ISSN: 25895370 NLM ISO Abbreviation: EClinicalMedicine Subsets: PubMed not MEDLINE
أسماء مطبوعة: Original Publication: [London] : The Lancet, [2018]-
مستخلص: Background: The evidence on prophylactic use of negative pressure wound therapy on primary closed incisional wounds (iNPWT) for the prevention of surgical site infections (SSI) is confusing and ambiguous. Implementation in daily practice is impaired by inconsistent recommendations in current international guidelines and published meta-analyses. More recently, multiple new randomised controlled trials (RCTs) have been published. We aimed to provide an overview of all meta-analyses and their characteristics; to conduct a new and up-to-date systematic review and meta-analysis and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment; and to explore the additive value of new RCTs with a trial sequential analysis (TSA).
Methods: PubMed, Embase and Cochrane CENTRAL databases were searched from database inception to October 24, 2022. We identified existing meta-analyses covering all surgical specialties and RCTs studying the effect of iNPWT compared with standard dressings in all types of surgery on the incidence of SSI, wound dehiscence, reoperation, seroma, hematoma, mortality, readmission rate, skin blistering, skin necrosis, pain, and adverse effects of the intervention. We calculated relative risks (RR) with corresponding 95% confidence intervals (CI) using a Mantel-Haenszel random-effects model. We assessed publication bias with a comparison-adjusted funnel plot. TSA was used to assess the risk of random error. The certainty of evidence was evaluated using the Cochrane Risk of Bias-2 (RoB2) tool and GRADE approach. This study is registered with PROSPERO, CRD42022312995.
Findings: We identified eight previously published general meta-analyses investigating iNPWT and compared their results to present meta-analysis. For the updated systematic review, 57 RCTs with 13,744 patients were included in the quantitative analysis for SSI, yielding a RR of 0.67 (95% CI: 0.59-0.76, I 2  = 21%) for iNPWT compared with standard dressing. Certainty of evidence was high. Compared with previous meta-analyses, the RR stabilised, and the confidence interval narrowed. In the TSA, the cumulative Z-curve crossed the trial sequential monitoring boundary for benefit, confirming the robustness of the summary effect estimate from the meta-analysis.
Interpretation: In this up-to-date meta-analysis, GRADE assessment shows high-certainty evidence that iNPWT is effective in reducing SSI, and uncertainty is less than in previous meta-analyses. TSA indicated that further trials are unlikely to change the effect estimate for the outcome SSI; therefore, if future research is to be conducted on iNPWT, it is crucial to consider what the findings will contribute to the existing robust evidence.
Funding: Dutch Association for Quality Funds Medical Specialists.
Competing Interests: MAB reported receiving institutional grants from J&J/Ethicon, 3M, and New Compliance; and being a speaker and/or instructor for J&J/Ethicon, 3M, BD Bard, Gore, Smith & Nephew, TelaBio, Angiodynamics, GDM, Medtronic. JHMG has given presentations for Smith & Nephew, unrelated to NPWT or this publication. RRS was former president of the committee for quality and safety in practice for the Dutch Anesthesiology Society. AME received a European Wound Managament grant. No other disclosures were reported. All other authors report no conflicts of interest.
(© 2023 The Author(s).)
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فهرسة مساهمة: Keywords: Incisional negative pressure wound therapy; Prevention; Surgical site infections; iNPWT
تواريخ الأحداث: Date Created: 20230804 Latest Revision: 20230805
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC10393772
DOI: 10.1016/j.eclinm.2023.102105
PMID: 37538540
قاعدة البيانات: MEDLINE
الوصف
تدمد:2589-5370
DOI:10.1016/j.eclinm.2023.102105