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Prophylactic Negative Pressure Wound Therapy for Obese Women After Cesarean Delivery: A Systematic Review and Meta-analysis

Smid, Marcela C. MD, MS; Dotters-Katz, Sarah K. MD; Grace, Matthew MD; Wright, Sarah T. MLS; Villers, Margaret S. MD, MSCR; Hardy-Fairbanks, Abbey MD; Stamilio, David M. MD, MSCE

doi: 10.1097/AOG.0000000000002259
Contents: Obesity: Review

OBJECTIVE: To summarize available studies on wound complication outcomes after prophylactic negative pressure wound therapy for obese women (body mass index 30 or greater).

DATA SOURCES: We conducted a systematic review and meta-analysis using electronic database search (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Google scholar, and Web of Science), Cochrane, and trial registries including ClinicalTrials.gov.

METHODS OF STUDY SELECTION: We conducted an electronic search of research articles from 1966 to January 2017 for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies of negative pressure wound therapy compared with standard dressing after cesarean delivery among obese women. Our primary outcome was defined as a composite of wound complication, including wound or surgical site infection, cellulitis, seroma, hematoma, wound disruption, or dehiscence. For cohort studies and RCTs, we performed a descriptive systematic review. For available RCTs, we performed a meta-analysis and pooled risk ratios using a random-effects model. We assessed for heterogeneity using χ2 test for heterogeneity and I2 test. We assessed for publication bias using a funnel plot.

TABULATION, INTEGRATION, AND RESULTS: Of 10 studies meeting eligibility criteria, five were RCTs and five were cohort studies. Results of cohort studies were varied; however, all had a high potential for selection bias. In the meta-analysis, there was no difference in primary composite outcome among those women with negative pressure wound therapy (16.8%) compared with those who had standard dressing (17.8%) (risk ratio 0.97, 95% CI 0.63–1.49). There was no statistically significant heterogeneity (χ2 test 4.80, P=.31, I2=17%).

CONCLUSION: Currently available evidence does not support negative pressure wound therapy use among obese women for cesarean wound complication prevention.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO: International prospective register of systematic reviews, 42016033948.

Currently available evidence is insufficient to support prophylactic negative pressure wound therapy placement among obese women after cesarean delivery.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Health Sciences Library, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.

Corresponding author: Marcela C. Smid, MD, MS, University of Utah, 30 N 1900 E, #2B200, Salt Lake City, UT 84312; email: Marcela.Smid@hsc.utah.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Drs. Stitely, Durnwald, Heine, Tuuli, and Looby, who contributed additional data for this study.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2017 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.