The effect of negative pressure wound therapy in reducing closed surgical site infections post-laparotomy

Abstract

Topic overview: Surgical site infections (SSI) are one of the most common complications post-laparotomies, leading to a decreased quality of life. Closed incision Negative Pressure Wound Therapy (NPWT) is a method of transmitting continuous negative pressure, to improve blood flow and preserve suture lines, lowering the incidence of external contamination. This dissertation aims to evaluate the effectiveness of NPWT on high risk closed laparotomy incisions to prevent SSI. The research question: Is Negative Pressure Wound Therapy effective in reducing closed surgical site wound infections post-laparotomy? PICO elements: The population studied included patients undergoing laparotomy surgery. The intervention under review included the use of closed incision NPWT, compared to the use of standard dressing. The expected outcome was SSI reduction. Inclusion and exclusion criteria: Adults who have undergone a laparotomy surgery and had closed incision NPWT applied were included. The use of NPWT on open wounds and individuals who have undergone non-abdominal operations were excluded. Methods: A systematic literature search was conducted using various databases to identify studies published in the last ten years that address the PICO question. The search was refined with the use of keywords, Boolean operators and an inclusion and exclusion criteria. The PRISMA Checklist and CASP tool were utilized to exclude irrelevant articles and critically appraise the literature. Results: The systematic search resulted in five key articles including 1 cohort study and 4 systematic reviews and meta-analysis. The findings indicated a positive link between closed incision NPWT and a reduction in SSI in laparotomy surgeries when compared to standard dressings. Conclusion: A definite conclusion cannot be provided due the limitations and heterogeneity present within the studies. However, this dissertation offers significant data demonstrating the benefits of closed incision NPWT as a preventive strategy to lower the rates of SSI. Nonetheless, further research is required. Implications and recommendations: One of the major recommendations for future practice is conducting trials with larger sample sizes, to sustain evidence-based practice. This is also recommended locally. By providing training, health care professionals will be encouraged to adapt this treatment among ideal candidates, ensuring optimal care delivery.