Prophylactic Negative Pressure Wound Therapy for Wound Complications after Cesarean Delivery: An evidence Synthesis

Objective: The effect of prophylactic negative pressure wound therapy (NPWT) for wound compilations after cesarean delivery remains controversial. The objective of study was to summarize available studies on wound complication outcomes after prophylactic NPWT for women undergoing cesarean delivery.

Methods: We systematically searched PubMed, EMBASE, the Cochrane Library and clinicaltrial.gov to identify randomized controlled trials (RCTs) that compared NPWT with standard wound dressing for cesarean delivery. The primary outcome was wound complications; the secondary outcome was surgical site infections (SSIs). Review Manager 5.3 was used to analyze the collected data. Risk ratio (RR) with 95% confidence interval (CI) was calculated using random-effects models. Cochrane’s Q test and the I² statistic were used to assess heterogeneity between studies.

Results: Seven RCTs involving 1504 participants were included in this meta-analysis. There was no difference in wound complications among those women with NPWT (20.5%) compared with those who with standard dressing (22.2%) (Six studies, RR=0.96, 95%CI=0.72-1.27, P=0.77), and there was no heterogeneity (χ² test=4.80, I²=0%; P=0.44). However, the risk of SSIs was significantly lower with the use of NPWT compared with standard dressing (Six studies, RR=0.64, 95%CI=0.46-0.89, P<0.01], and there was no heterogeneity (χ² test=3.35, I²=0%; P=0.65).

Conclusion: On the basis of current evidence, NPWT does not reduce the overall wound complications, but decrease the risk of SSIs at cesarean delivery. More well-designed RCTs are needed to confirm these findings.