Prophylactic
negative pressure wound therapy (NPWT) at cesarean delivery may reduce the
surgical site infections (SSI) and overall wound complications says the results
of a systematic review and meta-analysis published ahead of print in American journal
of obstetrics and gynecology.
Morbidly
obese women have a very high rate of SSIs and readmission to hospitals.
The
researchers conducted a literature review and included RCTs and observational
studies comparing surgical outcome between prophylactic negative pressure wound
closure and standard cesarean wound closure.
The
investigators were mainly looking at difference in SSI because of NPWT besides
other minor outcomes like composite wound complications, wound gaping,
hematoma, endometritis and readmission to the hospital.
Six RCTs and
three cohort study met the inclusion criteria. It was seen that women with NPWT
faced a 55% lower risk of SSI as compared to women with standard dressing (pooled
RR 0.45; 95% CI 0.31- 0.66). The Number Need to Treat (NNT) was 17.
Women with
NPWT also had a 22 lower risk of composite wound complications, while the other
minor outcomes were comparable in both the groups.
The authors
concluded that although the studies were heterogenous, use of NPWT decreases
the SSIs after cesarean, larger clinical
trials are awaited to fully understand the impact of the intervention.
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