Michał Kisielewski, Karolina Richter, Magdalena Pisarska-Adamczyk, Michał Wysocki, Nikola Kłos, Tomasz Stefura, Tomasz Wojewoda, Wojciech M Wysocki
{"title":"Incisional negative pressure wound therapy vs primary wound suturing after intestinal ostomy closure: a systematic review and meta-analysis.","authors":"Michał Kisielewski, Karolina Richter, Magdalena Pisarska-Adamczyk, Michał Wysocki, Nikola Kłos, Tomasz Stefura, Tomasz Wojewoda, Wojciech M Wysocki","doi":"10.1089/wound.2024.0100","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Wound infection after intestinal ostomy closure is common postoperative complication. An alternative to primary suturing (PS) of the wound is incisional negative pressure wound therapy (iNPWT). The aim of the article was to assess and compare clinical outcomes after PS and iNPWT.</p><p><strong>Approach: </strong>Strategy was aimed to find relevant data comparing outcomes of iNPWT and PS after ostomy closure. Search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases. Authors conducted a meta-analysis of parameters: wound healing time, surgical site infections, complications, length of stay.</p><p><strong>Results: </strong>The analysis revealed that iNPWT and control group did not differ significantly in wound healing time (OR = -2.06; 95% CI = -5.99-1.87; p=0.30, I2=4%). Meta-analysis of surgical site infection incidence revealed a significant difference favoring the incisional NPWT group versus observational (OR = 0.42; 95% CI = 0.25-0.72; p=0.002; I2=14%). Patients in iNPWT group had significantly lower incidence of complications than observational group (OR = 0.52; 95% CI = 0.35-0.77; p=0.001, I2=71%). Subgroup analysis limited to randomized studies only also presented significant differences favoring the iNPWT group against observational (OR = 0.27; 95% CI = 0.14-0.52; p<0.001, I2=67%). Our analysis revealed that LOS was not significantly different between groups among patients treated with iNPWT (IV=0.19; 95% CI = -0.66 -1,04; p=0.76, I2=0%). Subgroup analysis of randomized studies also did not present a significant difference (IV=0.25; 95% CI = -0.80 -1,30; p=0.33, I2=10%).</p><p><strong>Innovation: </strong>Study shows that the use of iNPWT can reduce surgical site infections with other complications (wound hematomas, wound seromas, wound dehiscence, fistulas, ileus) in patients undergoing intestinal ostomy closure without extended hospital stay.</p><p><strong>Conclusions: </strong>Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate of the most common complication after ostomy closure.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":null,"pages":null},"PeriodicalIF":5.8000,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Advances in wound care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/wound.2024.0100","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DERMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Wound infection after intestinal ostomy closure is common postoperative complication. An alternative to primary suturing (PS) of the wound is incisional negative pressure wound therapy (iNPWT). The aim of the article was to assess and compare clinical outcomes after PS and iNPWT.
Approach: Strategy was aimed to find relevant data comparing outcomes of iNPWT and PS after ostomy closure. Search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases. Authors conducted a meta-analysis of parameters: wound healing time, surgical site infections, complications, length of stay.
Results: The analysis revealed that iNPWT and control group did not differ significantly in wound healing time (OR = -2.06; 95% CI = -5.99-1.87; p=0.30, I2=4%). Meta-analysis of surgical site infection incidence revealed a significant difference favoring the incisional NPWT group versus observational (OR = 0.42; 95% CI = 0.25-0.72; p=0.002; I2=14%). Patients in iNPWT group had significantly lower incidence of complications than observational group (OR = 0.52; 95% CI = 0.35-0.77; p=0.001, I2=71%). Subgroup analysis limited to randomized studies only also presented significant differences favoring the iNPWT group against observational (OR = 0.27; 95% CI = 0.14-0.52; p<0.001, I2=67%). Our analysis revealed that LOS was not significantly different between groups among patients treated with iNPWT (IV=0.19; 95% CI = -0.66 -1,04; p=0.76, I2=0%). Subgroup analysis of randomized studies also did not present a significant difference (IV=0.25; 95% CI = -0.80 -1,30; p=0.33, I2=10%).
Innovation: Study shows that the use of iNPWT can reduce surgical site infections with other complications (wound hematomas, wound seromas, wound dehiscence, fistulas, ileus) in patients undergoing intestinal ostomy closure without extended hospital stay.
Conclusions: Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate of the most common complication after ostomy closure.
期刊介绍:
Advances in Wound Care rapidly shares research from bench to bedside, with wound care applications for burns, major trauma, blast injuries, surgery, and diabetic ulcers. The Journal provides a critical, peer-reviewed forum for the field of tissue injury and repair, with an emphasis on acute and chronic wounds.
Advances in Wound Care explores novel research approaches and practices to deliver the latest scientific discoveries and developments.
Advances in Wound Care coverage includes:
Skin bioengineering,
Skin and tissue regeneration,
Acute, chronic, and complex wounds,
Dressings,
Anti-scar strategies,
Inflammation,
Burns and healing,
Biofilm,
Oxygen and angiogenesis,
Critical limb ischemia,
Military wound care,
New devices and technologies.