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

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.

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.

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.

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.