Closed Incision Negative Pressure Therapy Management Versus Standard of Care Over Closed Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-Analysis of Comparative Studies

Introduction: Closed incision negative pressure therapy (ciNPT*) has been utilized to help manage closed incisions across many surgical specalities.1-6 This systematic review and meta-analysis evaluated the effect of ciNPT on post-surgical and health economic outcomes across published studies as well as subgroup analyses examining the effect of ciNPT on high-risk patients or procedures.

Methods: A systemic literature search using PubMed, EMBASE, and QUOSA was performed focusing on publications written in English, comparing ciNPT to traditional standard of care dressings between January 2005 and July 2021. Characteristics of study participants, surgical procedure, dressing used, duration of treatment, post-surgical outcomes, and length of follow up were extracted. Meta-analyses were performed using random-effects models. Risk ratios were used to summarize dichotomous outcomes. Mean differences were used to assess continuous variables reported on the same scale. Standardized mean differences were used if outcomes were reported on different scales or measurement instruments.

Results: The literature search resulted in a total of 84 studies available for analysis. Significant differences in surgical site complication (SSC) rates in favor of ciNPT use were found in the overall analysis of all studies and when the subgroup of high-risk studies were evaluated (p< 0.05). Surgical site infection (SSI), superficial SSI, deep SSI, seroma, dehiscence, skin necrosis, and prolonged incisional drainage analyses indicated lower rates in favor of ciNPT use both overall and for high-risk studies (p< 0.05). The benefit of ciNPT use in supporting reducing readmissions and subsequent reoperations were significant in favor of ciNPT (p< 0.05). ciNPT patients had a 0.9 day shorter hospital stay (p< 0.0001). These results remained consistent when analyses were performed on studies limited to high-risk patients. The difference in post-operative pain scores and the reported amounts of opioid usage were also significant in favor for ciNPT (p< 0.05).

Discussion: For these meta-analyses, the use of ciNPT was associated with a statistically significant reduction in the incidence of SSCs, SSIs, seroma, dehiscence, and skin necrosis. Reduced readmissions, ROR, and length of hospital stay were also observed in ciNPT patients as well as decreased pain and opioid use.