Incisional negative pressure wound therapy vs primary wound suturing after intestinal ostomy closure: a systematic review and meta-analysis.

IF 5.8 3区医学 Q1 DERMATOLOGY

Advances in wound care Pub Date : 2024-08-12 DOI:10.1089/wound.2024.0100

Michał Kisielewski, Karolina Richter, Magdalena Pisarska-Adamczyk, Michał Wysocki, Nikola Kłos, Tomasz Stefura, Tomasz Wojewoda, Wojciech M Wysocki

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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.

查看原文本刊更多论文

肠造口术后切口负压伤口疗法与原发性伤口缝合：系统回顾和荟萃分析。

目的：肠造口术后伤口感染是常见的术后并发症。切口负压伤口疗法（iNPWT）是伤口初次缝合（PS）的替代方法。文章旨在评估和比较PS和iNPWT治疗后的临床效果：策略：旨在寻找相关数据，比较造口关闭后 iNPWT 和 PS 的疗效。使用 MEDLINE/PubMed、ScienceDirect、EMBASE、Scopus、Cochrane 试验对照注册、SciELO 和 Web of Science 数据库进行了检索。作者对以下参数进行了荟萃分析：伤口愈合时间、手术部位感染、并发症、住院时间：分析结果显示，iNPWT组与对照组在伤口愈合时间上无显著差异（OR = -2.06；95% CI = -5.99-1.87；P=0.30，I2=4%）。手术部位感染发生率的 Meta 分析显示，切口 NPWT 组与观察组相比差异显著（OR = 0.42；95% CI = 0.25-0.72；P=0.002；I2=14%）。iNPWT组患者的并发症发生率明显低于观察组（OR=0.52；95% CI=0.35-0.77；P=0.001；I2=71%）。仅限于随机研究的分组分析也显示，iNPWT 组与观察组相比有显著差异（OR = 0.27；95% CI = 0.14-0.52；P=0.001）：研究表明，使用iNPWT可减少肠造口术患者手术部位感染及其他并发症（伤口血肿、伤口血清肿、伤口裂开、瘘管、回肠炎），且无需延长住院时间：选择性肠造口关闭术后护理中可考虑使用 iNPWT，以降低肠造口关闭术后最常见并发症的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in wound care Medicine-Emergency Medicine

CiteScore

12.10

自引率

4.10%

发文量

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.