Negative pressure incisional wound therapy for high-risk ventral hernia repair: a randomized controlled trial and meta-analysis.
Nathan E How, Yazan Abu Yousef, Jade Chow et al.
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In 30 seconds
This multicentre randomized controlled trial compared prophylactic negative pressure wound therapy (NPWT) with sterile dressings in adults with at least one risk factor for surgical-site complications undergoing ventral hernia repair; the authors also meta-analysed this trial with two other randomized trials. Among 107 patients with primary outcome data, surgical-site complications occurred in 15 (27.8%) of 54 NPWT recipients and 25 (47.2%) of 53 controls (relative risk 0.59, 95% CI 0.35 to 0.99). The pooled relative risk was 0.56 (95% CI 0.39 to 0.81). Postoperative quality of life was higher with NPWT, which the authors reported as cost-effective.
Key findings
- Surgical-site complications occurred in 15 (27.8%) of 54 patients receiving NPWT and 25 (47.2%) of 53 receiving sterile dressings (relative risk 0.59, 95% CI 0.35 to 0.99).
- Across three randomized trials, the pooled relative risk of surgical-site complications with NPWT was 0.56 (95% CI 0.39 to 0.81).
- HerQLes scores were 88.3 [95% CI 75.8 to 94.2] with NPWT and 73.3 [95% CI 52.5 to 93.3] with control dressings.
- The reported cost-effectiveness of NPWT was US$160 per quality-adjusted life year.
Why it matters
Wound complications are an important source of postoperative morbidity after ventral hernia repair. In this high-risk population, the trial and pooled randomized evidence suggest that prophylactic NPWT may reduce these complications, with higher reported postoperative quality-of-life scores. The findings also provide an economic estimate relevant to assessing this preventive approach.
What to keep in mind
Primary outcome data were available for 107 patients, and follow-up was a median of 33 days; longer-term outcomes are not reported in the abstract.