Effect of Negative Pressure Wound Therapy on Surgical Site Infections following Stoma Reversal in Colorectal Surgery: A Meta-Analysis

Figures & data

Figure 1. PRISMA flow chart of literature search.

Table 1. Characteristics of included studies.

Author, year, country, and study design	Sample size (I/C)	Sex (M:F I/C)	Age (I/C, year)	BMI (I/C, kg/m2)	Stoma type (Ileostomy: Colostomy I/C)	Antibiotic Therapy (Name/Dose/Time)	Intervention (Device/ Pressure /Duration)	Control	Wound closure	Diagnosis of SSI	Follow-up period (days)
Carrano, 2021, Italy/RCT	50/48	35:15 /31:17	56.32 ± 12.92 /55.08 ± 16.25	23.81 ± 3.38 /23.45 ± 3.66	41:9 /38:10	cefazolin /(20 mg/kg) /30 min before the incision	PICO-7 /80 mmHg /7 days	standard dressings and irrigation	PSS	CDC	30
Wierdak, 2020, Poland/RCT	35/36	24:11 /20:16	61.6 ± 11.3 /62.4 ± 11.3	26.2 ± 4.5 /26.2 ± 4.3	35:0 /36:0	second-generation cephalosporin /(20 mg/kg) /30 min before the incision	NANOVA /NM /3 days	standard dressing	LC	CDC and ECDC	30
Kojima, 2021, Japan/RCT	Group B /Group C /Control 10/10/10	8:2 /4:6 /6:4	69(48-75) /70(43-84) /64(48-82)	21.8(16.5-23.8) /20.3(17.0-26.2) /22.2(16.4-30.1)	10:0 /10:0 /10:0	NM	PICO /80 mmHg /7 or 14 days	standard dressings and irrigation	PSS	pus was observed in the wound	Not specified
Uchino, 2016, Japan/RCT	28/31	17:11 /23:8	48.1 ± 14.9 /40.4 ± 15.9	19.8 ± 4.3 /19.7 ± 3.8	28:0 /31:0	second-generation cephalosporin /(20 mg/kg) /30 min before the incision, repeated every 3 h during surgery, stopped at 24 h postoperatively	PICO /80 mmHg /14 days	standard dressing	PSS	CDC	28
Cantero, 2016, Spain /prospective	17/43	8:9 /20:23	64.7 /60.3	NM	17:0 /43:0	amoxicillin-clavulanic acid /2g /prior to surgery	Prevena /125 mmHg /5-7days	standard dressing	LC	CDC	30
Poehnert, 2017, Germany /prospective	24/25	12:12 /11:14	56.5(24-90) /56(18-83)	24(17-38) /25(15-36)	24:0 /25:0	ampicillin and sulbactam (3 g i.v.) or ceftriaxone (2 g i.v.) /prior to surgery	Prevena /125 mmHg /5 days	standard dressing	LC	CDC	30
Borejsza-Wysocki, 2021, Poland /prospective	15/15	7:8 /9:6	Overall 34.5(19-68)	22.7 ± 4.7 /25.9 ± 4.4	15:0 /15:0	cefazoline /2.0g /1h before skin incision and prolonged over the 24 h following the surgery	PICO /80 mmHg /a third change of NPWT at the time of discharge	standard dressing	LC	CDC	30
Curchod, 2022, Suisse /retrospective	85:252	51:34 /146:106	58 ± 17 /59 ± 16	25.8 ± 5 /24.7 ± 5.2	68:17 /217:35	NM	PICO/80 mmHg/5 days	standard dressing	LC	CDC	30
Yane, 2022, Japan /retrospective	40:63	29:11 /45:18	66(19-83) /66(19-87)	21.5(15.6-36.9) /21.8(15.0-30.9)	34:6 /51:12	flomoxef sodium /1g /30 min before the incision	V.A.C./75 mmHg/3 or 4 days, If the granulation did not cover, continued for another 3 days	standard dressing	I: PSS C: LC	CDC	30

I: NPWT group; C: nonpressure dressing group; sex (M: male; F: female); NM: not mentioned; PSS: purse-string suture; LC: linear skin closure; CDC: The Centers for Disease Control and Prevention; ECDC: European Center for Disease Prevention and Control. Continuous variables are presented as mean ± standard deviation or median (range). Kojima: Group B (NPWT weekly use), Group C (NPWT fortnightly use).

Figure 2. Risk of bias summary (present as high (+), low (-), or unclear (?)).

Table 2. Quality assessment for observational studies based on Newcastle-Ottawa scale.

Study	Selection				Comparability		Outcome			Total	Rating
	Exposed Cohort	Nonexposed Cohort	Ascertainment of exposure	Outcome of interest not present at start	Main factor	Additional factor	Assessment of outcome	Follow-up long enough	Adequacy of follow-up
Cantero 2016	1	1	1	0	1	0	0	1	1	6	medium
Poehnert 2017	1	1	1	0	1	1	1	1	1	8	high
Borejsza-Wysocki 2021	1	1	1	0	1	0	1	1	1	7	high
Curchod 2022	1	1	1	1	1	1	1	1	1	9	high
Yane 2022	1	1	1	1	1	0	1	1	1	8	high

Figure 3. Forest plots. (A) surgical site infection. (B) hematoma. (C) seroma. (D) length of hospital stay.