Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies
Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgical procedures but carry a risk of harmful and costly surgical site complications (SSCs). This systematic review and meta-analysis examined the impact of closed incision negative pressure therapy (ciNPT) on th...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344123000250 |
| _version_ | 1797780658737643520 |
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| author | H. John Cooper, MD Ronald P. Silverman, MD Ashley Collinsworth, ScD, MPH Christine Bongards, PhD Leah Griffin, MS |
| author_facet | H. John Cooper, MD Ronald P. Silverman, MD Ashley Collinsworth, ScD, MPH Christine Bongards, PhD Leah Griffin, MS |
| author_sort | H. John Cooper, MD |
| collection | DOAJ |
| description | Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgical procedures but carry a risk of harmful and costly surgical site complications (SSCs). This systematic review and meta-analysis examined the impact of closed incision negative pressure therapy (ciNPT) on the risk of SSCs following THA and TKA. Methods: A systematic literature review identified studies published between January 2005 and July 2021 comparing ciNPT (Prevena Incision Management System) to traditional standard-of-care dressings for patients undergoing THA and TKA. Meta-analyses were performed using a random effects model. A cost analysis was conducted using inputs from the meta-analysis and cost estimates from a national database. Results: Twelve studies met the inclusion criteria. Eight studies evaluated SSCs, where a significant difference was seen in favor of ciNPT (relative risk [RR]: 0.332, P < .001). Significant benefits in favor of ciNPT were also observed for surgical site infection (RR: 0.401, P = .016), seroma (RR: 0.473, P = .008), dehiscence (RR: 0.380, P = .014), prolonged incisional drainage (RR: 0.399, P = .003), and rate of return to the operating room (RR: 0.418, P = .001). The estimated cost savings attributed to ciNPT use was $932 per patient. Conclusions: The use of ciNPT after TKA and THA was associated with a significant reduction in the risk of SSCs, including surgical site infections, seroma, dehiscence, and prolonged incisional drainage. The risk of reoperation was reduced as were the costs of care in the modeled cost analysis, suggesting a potential for both economic and clinical advantages for ciNPT over standard-of-care dressings, particularly in high-risk patients. |
| first_indexed | 2024-03-12T23:47:06Z |
| format | Article |
| id | doaj.art-1cec73ead25045a9ba6df326335744fa |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-03-12T23:47:06Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-1cec73ead25045a9ba6df326335744fa2023-07-14T04:27:54ZengElsevierArthroplasty Today2352-34412023-06-0121101120Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative StudiesH. John Cooper, MD0Ronald P. Silverman, MD1Ashley Collinsworth, ScD, MPH2Christine Bongards, PhD3Leah Griffin, MS4Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA3M Company, Saint Paul, MN, USA; University of Maryland School of Medicine, Baltimore, MD, USA3M Company, Saint Paul, MN, USA; Corresponding author. Medical Solutions Division, 3M Company, 12930 W Interstate 10, San Antonio, TX 78249, USA. Tel.: +1 469 990 6578.3M Company, Saint Paul, MN, USA3M Company, Saint Paul, MN, USABackground: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common surgical procedures but carry a risk of harmful and costly surgical site complications (SSCs). This systematic review and meta-analysis examined the impact of closed incision negative pressure therapy (ciNPT) on the risk of SSCs following THA and TKA. Methods: A systematic literature review identified studies published between January 2005 and July 2021 comparing ciNPT (Prevena Incision Management System) to traditional standard-of-care dressings for patients undergoing THA and TKA. Meta-analyses were performed using a random effects model. A cost analysis was conducted using inputs from the meta-analysis and cost estimates from a national database. Results: Twelve studies met the inclusion criteria. Eight studies evaluated SSCs, where a significant difference was seen in favor of ciNPT (relative risk [RR]: 0.332, P < .001). Significant benefits in favor of ciNPT were also observed for surgical site infection (RR: 0.401, P = .016), seroma (RR: 0.473, P = .008), dehiscence (RR: 0.380, P = .014), prolonged incisional drainage (RR: 0.399, P = .003), and rate of return to the operating room (RR: 0.418, P = .001). The estimated cost savings attributed to ciNPT use was $932 per patient. Conclusions: The use of ciNPT after TKA and THA was associated with a significant reduction in the risk of SSCs, including surgical site infections, seroma, dehiscence, and prolonged incisional drainage. The risk of reoperation was reduced as were the costs of care in the modeled cost analysis, suggesting a potential for both economic and clinical advantages for ciNPT over standard-of-care dressings, particularly in high-risk patients.http://www.sciencedirect.com/science/article/pii/S2352344123000250Negative pressure wound therapyTotal hip arthroplastyTotal knee arthroplastySurgical site complicationSurgical site infection |
| spellingShingle | H. John Cooper, MD Ronald P. Silverman, MD Ashley Collinsworth, ScD, MPH Christine Bongards, PhD Leah Griffin, MS Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies Arthroplasty Today Negative pressure wound therapy Total hip arthroplasty Total knee arthroplasty Surgical site complication Surgical site infection |
| title | Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies |
| title_full | Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies |
| title_fullStr | Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies |
| title_full_unstemmed | Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies |
| title_short | Closed Incision Negative Pressure Therapy vs Standard of Care Over Closed Knee and Hip Arthroplasty Surgical Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-analysis of Comparative Studies |
| title_sort | closed incision negative pressure therapy vs standard of care over closed knee and hip arthroplasty surgical incisions in the reduction of surgical site complications a systematic review and meta analysis of comparative studies |
| topic | Negative pressure wound therapy Total hip arthroplasty Total knee arthroplasty Surgical site complication Surgical site infection |
| url | http://www.sciencedirect.com/science/article/pii/S2352344123000250 |
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