Negative pressure wound therapy for colorectal incisions: a systematic review and meta-analysis of controlled trials.

IF 1.5 4区医学 Q3 DERMATOLOGY

Journal of wound care Pub Date : 2025-07-02 DOI:10.12968/jowc.2022.0219

Ting-Kuang Wang, Chien-Hsin Chen, Wen-Kuan Chiu, Cheng-Hua Ni, Chin-Yun Wang, Kee-Hsin Chen, Chiehfeng Chen

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引用次数: 0

Abstract

Objective: Negative pressure wound therapy (NPWT) has demonstrated promising results in reducing surgical site infection (SSI) rates following orthopaedic, vascular, cardiothoracic, plastic and abdominal surgery. The literature on use of NPWT on colorectal incisions is growing, with several randomised controlled trials (RCTs); however, findings have been inconsistent. This review evaluated the effectiveness and safety of NPWT for colorectal incisions in elective and emergency surgery.

Method: The Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and ClinicalTrials.gov databases were searched for RCTs and non-RCTs comparing NPWT with standard of care.

Results: A total of five RCTs and six non-RCTs were included (with a total number of patients 2193). NPWT significantly reduced the rate of infection in colorectal incisions (odds ratio (OR): 0.57; 95% confidence interval (CI): 0.41, 0.78; I²=14%; p<0.0005) and wound complications of the colorectal surgical incisions (OR: 0.33; 95% CI: 0.13, 0.88; I²=59%; p=0.03). NPWT also shortened the wound healing time by three days (mean difference: -2.98; 95% CI: -4.99, -0.97; I²=0%; p=0.004). Subgroup analysis revealed that NPWT conferred greater benefits on wounds resulting from life-threatening emergency surgery, and contaminated or dirty-infected wounds.

Conclusion: The findings of this review showed that NPWT is an effective intervention for the closure of wounds in patients following colorectal surgery, and lead to a significant reduction in SSIs, overall wound complications, and mean complete wound healing time. It was particularly effective in emergency cases and in contaminated to dirty-infected wounds. Treatment options should be considered in terms of cost-benefits and adequate patient selection during shared decision-making.

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负压伤口治疗结直肠切口：对照试验的系统回顾和荟萃分析。

目的：负压伤口治疗（NPWT）在降低骨科、血管、心胸外科、整形外科和腹部外科手术后手术部位感染（SSI）发生率方面显示出良好的效果。使用NPWT治疗结直肠切口的文献越来越多，有几个随机对照试验（rct）；然而，调查结果并不一致。本综述评价了NPWT在择期和急诊结肠切口手术中的有效性和安全性。方法：检索Cochrane中央对照试验注册库、PubMed、EMBASE、护理和联合健康文献累积索引和ClinicalTrials.gov数据库，检索比较NPWT与标准护理的随机对照试验和非随机对照试验。结果：共纳入5项rct和6项非rct（共2193例患者）。NPWT显著降低结直肠切口感染率(优势比（OR）： 0.57；95%置信区间（CI）： 0.41, 0.78；I2 = 14%;p2 = 59%;p = 0.03)。NPWT可使创面愈合时间缩短3天(平均差值：-2.98；95% ci: -4.99, -0.97；I2 = 0%;p = 0.004)。亚组分析显示，NPWT对因危及生命的紧急手术造成的伤口以及受污染或肮脏感染的伤口有更大的益处。结论：本综述的研究结果表明，NPWT是一种有效的结肠直肠癌术后伤口闭合干预措施，可显著减少ssi、整体伤口并发症和平均伤口完全愈合时间。它对急诊病例和被污染到肮脏感染的伤口特别有效。在共同决策过程中，治疗方案应考虑成本效益和充分的患者选择。

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来源期刊

Journal of wound care DERMATOLOGY-

CiteScore

2.90

自引率

10.50%

发文量

215

期刊介绍： Journal of Wound Care (JWC) is the definitive wound-care journal and the leading source of up-to-date research and clinical information on everything related to tissue viability. The journal was first launched in 1992 and aimed at catering to the needs of the multidisciplinary team. Published monthly, the journal’s international audience includes nurses, doctors and researchers specialising in wound management and tissue viability, as well as generalists wishing to enhance their practice. In addition to cutting edge and state-of-the-art research and practice articles, JWC also covers topics related to wound-care management, education and novel therapies, as well as JWC cases supplements, a supplement dedicated solely to case reports and case series in wound care. All articles are rigorously peer-reviewed by a panel of international experts, comprised of clinicians, nurses and researchers. Specifically, JWC publishes: High quality evidence on all aspects of wound care, including leg ulcers, pressure ulcers, the diabetic foot, burns, surgical wounds, wound infection and more The latest developments and innovations in wound care through both preclinical and preliminary clinical trials of potential new treatments worldwide In-depth prospective studies of new treatment applications, as well as high-level research evidence on existing treatments Clinical case studies providing information on how to deal with complex wounds Comprehensive literature reviews on current concepts and practice, including cost-effectiveness Updates on the activities of wound care societies around the world.