The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis
Background Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing a...
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| Veröffentlicht in: | World journal of surgery 2020-05, Vol.44 (5), p.1526-1537 |
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| creator | Cagney, David Simmons, Lydia O’Leary, Donal Peter Corrigan, Mark Kelly, Louise O’Sullivan, M. J. Liew, Aaron Redmond, Henry Paul |
| description | Background
Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery.
Methods
This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis.
Results
Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19–069;
P
= 0.002], SSI (OR 0.45; 95% CI 0.24–0.86;
P
= 0.015), seroma (OR 0.28; 95% CI 0.13–0.59;
P
= 0.001), wound dehiscence (OR 0.49; 95% CI 0.32–0.72;
P
|
| doi_str_mv | 10.1007/s00268-019-05335-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2333608578</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2333608578</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4264-ca57329388387362bba3c5902d24274dc7e1f928ec1e254c486163a271538a3</originalsourceid><addsrcrecordid>eNqNkc1u1DAUhS0EokPhBVggS2zYBGzfxHG6m45aWlR-xFTq0vI4N62rTDy1k7Z5BZ66DikgsUCsbFnfOTrWR8hrzt5zxsoPkTEhVcZ4lbECoMjun5AFz0FkAgQ8JQsGMk93DnvkRYzXjPFSMvmc7AGvGCukWpAf51dIj5rGWWNH6hv6Lfjd1dga2ztLv-Cl6d0tpleMcQhIL_zQ1TSFgtmNtPGBrlofsaannXXR-S5S19HDgCb2dD2ESwzjAV3S9Rh73Jqp9DveOryjJvV8xt5ky860Y3TxJXnWmDbiq8dzn6yPj85XJ9nZ14-nq-VZZnOR_mNNUYKoQClQJUix2RiwRcVELXJR5rUtkTeVUGg5iiK3uZJcghElL0AZ2Cfv5tZd8DcDxl5vXbTYtqZDP0QtAEAyVZQqoW__Qq_9ENLaiVJFKq_kRImZssHHGLDRu-C2JoyaMz150rMnnTzpn570fQq9eaweNlusf0d-iUnAwQzcuRbH_6jUF5_Wh8dsUp7CMIdjynVJwZ_h_9j0APKJrwI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2385254968</pqid></control><display><type>article</type><title>The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Cagney, David ; Simmons, Lydia ; O’Leary, Donal Peter ; Corrigan, Mark ; Kelly, Louise ; O’Sullivan, M. J. ; Liew, Aaron ; Redmond, Henry Paul</creator><creatorcontrib>Cagney, David ; Simmons, Lydia ; O’Leary, Donal Peter ; Corrigan, Mark ; Kelly, Louise ; O’Sullivan, M. J. ; Liew, Aaron ; Redmond, Henry Paul</creatorcontrib><description>Background
Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery.
Methods
This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis.
Results
Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19–069;
P
= 0.002], SSI (OR 0.45; 95% CI 0.24–0.86;
P
= 0.015), seroma (OR 0.28; 95% CI 0.13–0.59;
P
= 0.001), wound dehiscence (OR 0.49; 95% CI 0.32–0.72;
P
< 0.001) and wound necrosis (OR 0.38; 95% CI 0.19–0.78;
P
= 0.008). There was no significant difference in haematoma rate (OR 0.8; 95% CI 0.19–3.2;
P
= 0.75). Statistically significant heterogeneity existed for total wound complications, but no other outcomes.
Conclusion
Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-019-05335-x</identifier><identifier>PMID: 31900568</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; Bandages ; Breast ; Breast - surgery ; Cardiac Surgery ; Complications ; Dehiscence ; Dressings ; General Surgery ; Hematoma ; Hematoma - prevention & control ; Heterogeneity ; Humans ; Infectious diseases ; Lymphatic drainage ; Medicine ; Medicine & Public Health ; Meta-analysis ; Necrosis ; Negative-Pressure Wound Therapy ; Pressure ; Pressure ulcers ; Scientific Review ; Seroma - prevention & control ; Statistical analysis ; Surgery ; Surgical site infections ; Surgical Wound - therapy ; Surgical Wound Dehiscence - prevention & control ; Surgical Wound Infection - prevention & control ; Systematic review ; Thoracic Surgery ; Vascular Surgery ; Wound Healing</subject><ispartof>World journal of surgery, 2020-05, Vol.44 (5), p.1526-1537</ispartof><rights>Société Internationale de Chirurgie 2020</rights><rights>2020 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>Société Internationale de Chirurgie 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4264-ca57329388387362bba3c5902d24274dc7e1f928ec1e254c486163a271538a3</citedby><cites>FETCH-LOGICAL-c4264-ca57329388387362bba3c5902d24274dc7e1f928ec1e254c486163a271538a3</cites><orcidid>0000-0001-5505-3175</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-019-05335-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-019-05335-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,41464,42533,45550,45551,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31900568$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cagney, David</creatorcontrib><creatorcontrib>Simmons, Lydia</creatorcontrib><creatorcontrib>O’Leary, Donal Peter</creatorcontrib><creatorcontrib>Corrigan, Mark</creatorcontrib><creatorcontrib>Kelly, Louise</creatorcontrib><creatorcontrib>O’Sullivan, M. J.</creatorcontrib><creatorcontrib>Liew, Aaron</creatorcontrib><creatorcontrib>Redmond, Henry Paul</creatorcontrib><title>The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery.
Methods
This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis.
Results
Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19–069;
P
= 0.002], SSI (OR 0.45; 95% CI 0.24–0.86;
P
= 0.015), seroma (OR 0.28; 95% CI 0.13–0.59;
P
= 0.001), wound dehiscence (OR 0.49; 95% CI 0.32–0.72;
P
< 0.001) and wound necrosis (OR 0.38; 95% CI 0.19–0.78;
P
= 0.008). There was no significant difference in haematoma rate (OR 0.8; 95% CI 0.19–3.2;
P
= 0.75). Statistically significant heterogeneity existed for total wound complications, but no other outcomes.
Conclusion
Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.</description><subject>Abdominal Surgery</subject><subject>Bandages</subject><subject>Breast</subject><subject>Breast - surgery</subject><subject>Cardiac Surgery</subject><subject>Complications</subject><subject>Dehiscence</subject><subject>Dressings</subject><subject>General Surgery</subject><subject>Hematoma</subject><subject>Hematoma - prevention & control</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Lymphatic drainage</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Necrosis</subject><subject>Negative-Pressure Wound Therapy</subject><subject>Pressure</subject><subject>Pressure ulcers</subject><subject>Scientific Review</subject><subject>Seroma - prevention & control</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surgical site infections</subject><subject>Surgical Wound - therapy</subject><subject>Surgical Wound Dehiscence - prevention & control</subject><subject>Surgical Wound Infection - prevention & control</subject><subject>Systematic review</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><subject>Wound Healing</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkc1u1DAUhS0EokPhBVggS2zYBGzfxHG6m45aWlR-xFTq0vI4N62rTDy1k7Z5BZ66DikgsUCsbFnfOTrWR8hrzt5zxsoPkTEhVcZ4lbECoMjun5AFz0FkAgQ8JQsGMk93DnvkRYzXjPFSMvmc7AGvGCukWpAf51dIj5rGWWNH6hv6Lfjd1dga2ztLv-Cl6d0tpleMcQhIL_zQ1TSFgtmNtPGBrlofsaannXXR-S5S19HDgCb2dD2ESwzjAV3S9Rh73Jqp9DveOryjJvV8xt5ky860Y3TxJXnWmDbiq8dzn6yPj85XJ9nZ14-nq-VZZnOR_mNNUYKoQClQJUix2RiwRcVELXJR5rUtkTeVUGg5iiK3uZJcghElL0AZ2Cfv5tZd8DcDxl5vXbTYtqZDP0QtAEAyVZQqoW__Qq_9ENLaiVJFKq_kRImZssHHGLDRu-C2JoyaMz150rMnnTzpn570fQq9eaweNlusf0d-iUnAwQzcuRbH_6jUF5_Wh8dsUp7CMIdjynVJwZ_h_9j0APKJrwI</recordid><startdate>202005</startdate><enddate>202005</enddate><creator>Cagney, David</creator><creator>Simmons, Lydia</creator><creator>O’Leary, Donal Peter</creator><creator>Corrigan, Mark</creator><creator>Kelly, Louise</creator><creator>O’Sullivan, M. J.</creator><creator>Liew, Aaron</creator><creator>Redmond, Henry Paul</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5505-3175</orcidid></search><sort><creationdate>202005</creationdate><title>The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis</title><author>Cagney, David ; Simmons, Lydia ; O’Leary, Donal Peter ; Corrigan, Mark ; Kelly, Louise ; O’Sullivan, M. J. ; Liew, Aaron ; Redmond, Henry Paul</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4264-ca57329388387362bba3c5902d24274dc7e1f928ec1e254c486163a271538a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Bandages</topic><topic>Breast</topic><topic>Breast - surgery</topic><topic>Cardiac Surgery</topic><topic>Complications</topic><topic>Dehiscence</topic><topic>Dressings</topic><topic>General Surgery</topic><topic>Hematoma</topic><topic>Hematoma - prevention & control</topic><topic>Heterogeneity</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Lymphatic drainage</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Necrosis</topic><topic>Negative-Pressure Wound Therapy</topic><topic>Pressure</topic><topic>Pressure ulcers</topic><topic>Scientific Review</topic><topic>Seroma - prevention & control</topic><topic>Statistical analysis</topic><topic>Surgery</topic><topic>Surgical site infections</topic><topic>Surgical Wound - therapy</topic><topic>Surgical Wound Dehiscence - prevention & control</topic><topic>Surgical Wound Infection - prevention & control</topic><topic>Systematic review</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><topic>Wound Healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cagney, David</creatorcontrib><creatorcontrib>Simmons, Lydia</creatorcontrib><creatorcontrib>O’Leary, Donal Peter</creatorcontrib><creatorcontrib>Corrigan, Mark</creatorcontrib><creatorcontrib>Kelly, Louise</creatorcontrib><creatorcontrib>O’Sullivan, M. J.</creatorcontrib><creatorcontrib>Liew, Aaron</creatorcontrib><creatorcontrib>Redmond, Henry Paul</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cagney, David</au><au>Simmons, Lydia</au><au>O’Leary, Donal Peter</au><au>Corrigan, Mark</au><au>Kelly, Louise</au><au>O’Sullivan, M. J.</au><au>Liew, Aaron</au><au>Redmond, Henry Paul</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2020-05</date><risdate>2020</risdate><volume>44</volume><issue>5</issue><spage>1526</spage><epage>1537</epage><pages>1526-1537</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery.
Methods
This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis.
Results
Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19–069;
P
= 0.002], SSI (OR 0.45; 95% CI 0.24–0.86;
P
= 0.015), seroma (OR 0.28; 95% CI 0.13–0.59;
P
= 0.001), wound dehiscence (OR 0.49; 95% CI 0.32–0.72;
P
< 0.001) and wound necrosis (OR 0.38; 95% CI 0.19–0.78;
P
= 0.008). There was no significant difference in haematoma rate (OR 0.8; 95% CI 0.19–3.2;
P
= 0.75). Statistically significant heterogeneity existed for total wound complications, but no other outcomes.
Conclusion
Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31900568</pmid><doi>10.1007/s00268-019-05335-x</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-5505-3175</orcidid></addata></record> |
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| ispartof | World journal of surgery, 2020-05, Vol.44 (5), p.1526-1537 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; Wiley Online Library Journals Frontfile Complete |
| subjects | Abdominal Surgery Bandages Breast Breast - surgery Cardiac Surgery Complications Dehiscence Dressings General Surgery Hematoma Hematoma - prevention & control Heterogeneity Humans Infectious diseases Lymphatic drainage Medicine Medicine & Public Health Meta-analysis Necrosis Negative-Pressure Wound Therapy Pressure Pressure ulcers Scientific Review Seroma - prevention & control Statistical analysis Surgery Surgical site infections Surgical Wound - therapy Surgical Wound Dehiscence - prevention & control Surgical Wound Infection - prevention & control Systematic review Thoracic Surgery Vascular Surgery Wound Healing |
| title | The Efficacy of Prophylactic Negative Pressure Wound Therapy for Closed Incisions in Breast Surgery: A Systematic Review and Meta-Analysis |
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