Effects of Negative-Pressure Wound Therapy With Instillation versus Standard of Care in Multiple Wound Types: Systematic Literature Review and Meta-Analysis.

Abstract

Large randomized controlled trials that evaluate the effects of negative-pressure wound therapy with instillation of a topical solution and dwell time (NPWTi-d) are lacking. There is a need to synthesize existing data across multiple studies to provide a more precise estimate of the clinical effects of NPWTi-d. A systematic literature review and a meta-analysis of comparative studies were performed to determine the effects of NPWTi-d versus control therapy in the adjunctive management of complex wounds. Weighted standardized mean difference or odds ratios and 95% confidence intervals were calculated to pool study and control group results in each publication for analysis. Thirteen studies comprising 720 patients were included in the analysis. Significantly fewer surgical debridements were performed in NPWTi-d patients versus control patients (P = 0.01). Wounds in the NPWTi-d group were ready for closure faster than control wounds (P = 0.03). The odds of reducing bacterial count from baseline in the NPWTi-d group was 4.4 times greater than control group wounds (P = 0.003), and percent reduction of bacterial count in NPWTi-d wounds was evident in all studies that captured that endpoint. There was a significantly shorter length of therapy in NPWTi-d patients versus control patients (P = 0.03). Wounds in NPWTi-d group were 2.39 times more likely to close than control group wounds (P = 0.01). Length of hospital stay was not significantly reduced for NPWTi-d patients compared with that for control patients (P = 0.06). Results of this meta-analysis show a positive effect with use of NPWTi-d in various wound types.